Individual
MRS. MARY DIANE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4110 3RD ST, TILLAMOOK, OR 97141-2804
(503) 842-2788
Mailing address
208 DOUGLAS AVE, TILLAMOOK, OR 97141-2025
(503) 354-2315
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
000007279
OR
Other
Enumeration date
03/09/2013
Last updated
03/09/2013
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