Individual
AMY PATRICIA THEALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
700 S J ST, LAKEVIEW, OR 97630-1623
(541) 947-2114
Mailing address
501 S G ST, LAKEVIEW, OR 97630-1827
(414) 507-6218
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2020167949
OR
Other
Enumeration date
01/23/2019
Last updated
06/21/2021
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