SID KEOMANIVONG
Nurse Practitioner - Primary Care
Active
Individual
NPI: 1760960462
Specialties
| Specialty | Code | Primary | License |
|---|---|---|---|
| Nurse Practitioner - Primary Care | 363LP2300X | Yes | 201806379NP-PP (OR) |
Frequently Asked Questions
NPI 1760960462 is the National Provider Identifier for SID KEOMANIVONG, a Nurse Practitioner - Primary Care provider located in Central Point, OR. This NPI was enumerated on August 3, 2018.
SID KEOMANIVONG practices at 2677 BEALL LN, Central Point, OR 97502.
Quick Facts
- NPI
- 1760960462
- Type
- Individual
- Enumerated
- Aug 3, 2018
- Last Updated
- Oct 8, 2019
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