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Organization

CORVALLIS PEDIATRICS, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KOURTNEY HANKS FNP-C, CNM (NURSE PRACTITIONER)
(541) 745-8715
Entity
Organization

Contact information

Practice address
1873 NW KINGS BLVD, CORVALLIS, OR 97330-1907
(541) 745-8715
Mailing address
1873 NW KINGS BLVD, CORVALLIS, OR 97330-1907

Taxonomy

Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1013371707
OR
Enumeration date
07/10/2025
Last updated
07/10/2025
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