Individual
ELIZABETH DIVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP
Contact information
Practice address
1744 E MCANDREWS RD STE B, MEDFORD, OR 97504-5576
(503) 965-0349
Mailing address
1744 E MCANDREWS RD STE B, MEDFORD, OR 97504-5576
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
10021024
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/05/2021
Last updated
01/13/2026
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