Organization
FOUR RIVERS HEALTHCARE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JODY AILEEN STARK FNP (PRESIDENT)
(541) 889-2244
Entity
Organization
Contact information
Practice address
932 W IDAHO AVE STE 100, ONTARIO, OR 97914-2155
(541) 889-2244
(541) 889-2626
Mailing address
640 SW 4TH AVE, ONTARIO, OR 97914-2625
(541) 889-3510
(541) 889-3510
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
200550081NP
OR
364SF0001X
Family Health Clinical Nurse Specialist
Primary
07904
OR
Other
Enumeration date
10/16/2009
Last updated
10/16/2009
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