Organization
LWAFP PC INC
Active
Other names
Living Water Adult Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA MAHONEY MSN, FNP (PRESIDENT)
(541) 474-9400
Entity
Organization
Contact information
Practice address
181 NW BUNNELL AVE, GRANTS PASS, OR 97526-6012
(541) 474-9400
Mailing address
PO BOX 1925, GRANTS PASS, OR 97528-0163
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
08/07/2008
Last updated
08/07/2008
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