Organization
CANYON CREEK CHIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAWNA CLARK FNP (MEMBER)
(541) 575-1263
Entity
Organization
Contact information
Practice address
235 S CANYON BLVD, JOHN DAY, OR 97845-1044
(541) 575-1263
(541) 575-0233
Mailing address
235 S CANYON BLVD, JOHN DAY, OR 97845-1044
(541) 575-1263
(541) 575-0233
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
10/21/2022
Last updated
10/21/2022
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