Individual
MISTY ELIZABETH VICENTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
1716 WILLIAMS HWY, GRANTS PASS, OR 97527-5661
(541) 474-6053
Mailing address
82 SCRUB OAK DR, STAR VALLEY RANCH, WY 83127-5125
(307) 226-4075
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
10032608
OR
Other
Enumeration date
09/18/2024
Last updated
09/18/2024
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