Organization
PEDIATRIC TLC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YVONNE MARTENIA FNP-BC (OWNER)
(547) 479-2411
Entity
Organization
Contact information
Practice address
1819 NEBRASKA AVE, GRANTS PASS, OR 97527-5701
(541) 479-2411
Mailing address
1819 NEBRASKA AVE, GRANTS PASS, OR 97527-5701
(541) 479-2411
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
—
—
Other
Enumeration date
09/14/2021
Last updated
08/25/2022
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