Individual
CARLY MAUCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1813 W HARVARD AVE, SUITE #310, ROSEBURG, OR 97471-2752
(541) 672-7546
Mailing address
2423 NW TROOST ST, ROSEBURG, OR 97471-1706
(541) 677-3400
(541) 677-3405
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA01409
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R144364
PTAN
OR
Enumeration date
01/08/2008
Last updated
11/29/2017
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