Individual
MABEL Y DZATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM RNP
Contact information
Practice address
1373 N 10TH AVE, STAYTON, OR 97383-2037
(503) 769-9522
(503) 769-9530
Mailing address
1373 N 10TH AVE, STAYTON, OR 97383-2037
(503) 769-9522
(503) 769-9530
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
200050056NP NMNP PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000855
—
OR
Enumeration date
07/12/2006
Last updated
05/09/2013
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