Individual
KATHLEEN M WAYBRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1813 W HARVARD AVE, STE 201, ROSEBURG, OR 97471-2754
(541) 440-6390
(541) 440-6392
Mailing address
1813 W HARVARD AVE, STE 201, ROSEBURG, OR 97471-2754
(541) 440-6390
(541) 440-6392
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
80045889N1
OR
363LF0000X
Family Nurse Practitioner
Primary
080045889N1
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
154971
—
OR
05
—
168395
—
OR
01
—
R103163
MCR PART B
—
Enumeration date
02/09/2006
Last updated
11/29/2018
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