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Individual

MS. RETA L VINING

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ANP-BC

Contact information

Practice address
2440 HARTMAN LANE, 200, SPRINGFIELD, OR 97877
(541) 205-1192
Mailing address
2440 HARTMAN LANE, 200, SPRINGFIELD, OR 97877
(541) 205-1192

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
08652
OH
363LA2200X
Adult Health Nurse Practitioner
Primary
200450030NP ANP PP
OR
363LA2200X
Adult Health Nurse Practitioner
2011031615
MO
363LA2200X
Adult Health Nurse Practitioner
60081469
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0864364
OR
Enumeration date
04/10/2006
Last updated
08/16/2016
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