Individual
EDEN FAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
1315 NW 4TH ST APT A, REDMOND, OR 97756-1328
(541) 548-7761
(541) 598-3485
Mailing address
1805 E 19TH ST, THE DALLES, OR 97058-3365
(541) 296-2201
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
202008004NP-PP
OR
Other
Enumeration date
09/25/2020
Last updated
04/07/2026
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