Individual
HALLIE IVERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 E MAIN ST STE C, MEDFORD, OR 97501-6041
(541) 200-2900
(541) 200-2948
Mailing address
3587 HEATHROW WAY, MEDFORD, OR 97504-4004
(541) 858-8170
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
201408131
OR
Other
Enumeration date
06/07/2016
Last updated
03/01/2017
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