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Individual

SALLY BEAVERS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RN

Contact information

Practice address
29984 ELLENSBURG AVE, GOLD BEACH, OR 97444
(541) 469-0405
Mailing address
PO BOX 434, GOLD BEACH, OR 97444-0434
(541) 469-0405

Taxonomy

Speciality
Code
Description
License number
State
163WW0000X
Wound Care Registered Nurse
Primary
200842276RN
OR

Other

Enumeration date
12/04/2012
Last updated
01/11/2013
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