Individual
LARISA KRAVCHUK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
805 FIR CONE DR NE, KEIZER, OR 97303-4328
(503) 463-6508
Mailing address
805 FIR CONE DR NE, KEIZER, OR 97303-4328
(503) 463-6508
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
OR
Other
Enumeration date
10/15/2018
Last updated
10/15/2018
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