Individual
MEMORY KNIGHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
283 SE FOWLER ST STE 2, ROSEBURG, OR 97470-3309
(541) 464-6455
(541) 464-6457
Mailing address
283 SE FOWLER ST STE 2, ROSEBURG, OR 97470-3309
(541) 464-6455
(541) 464-6457
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
11/05/2019
Last updated
05/13/2021
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