Individual
KIM R CANTWELL-GAB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1698 E MCANDREWS RD, SUITE 300, MEDFORD, OR 97504-5589
(541) 732-7850
Mailing address
520 MEDICAL CENTER DR, STE 200, MEDFORD, OR 97504-4314
(541) 732-7850
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
201503207NP-PP
OR
363L00000X
Nurse Practitioner
AP30007760
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9653080
—
WA
Enumeration date
07/16/2007
Last updated
09/24/2020
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