Individual
MR. GLEN MARVIN INTERMILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNFA
Contact information
Practice address
1222 CRAIGLEA DR, EAGLE POINT, OR 97524-9617
(541) 535-3820
(541) 535-3821
Mailing address
1222 CRAIGLEA DR, EAGLE POINT, OR 97524-9617
(541) 535-3820
(541) 535-3821
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
Primary
—
OR
Other
Enumeration date
11/15/2006
Last updated
07/08/2007
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