Individual
KAYLA MARIE STREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
435 LANCASTER DR NE, SALEM, OR 97301-4729
(503) 585-6388
(503) 585-0669
Mailing address
435 LANCASTER DR NE, SALEM, OR 97301-4729
(503) 585-6388
(503) 585-0669
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA156112
OR
Other
Enumeration date
01/10/2012
Last updated
02/07/2012
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