Individual provider · Type 1 NPI
Sid Christian Keomanivong
Primary Care Nurse Practitioner · Central Point, OR
NPI number
1760960462
Active
Practice location
2677 Beall Ln
Central Point, OR 97502-1462
Mailing address
3344 Winterhaven St, Unit 101
Las Vegas, NV 89108-5064
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Primary Care Nurse Practitioner Primary | 363LP2300X | 201806379NP-PP (OR) |
Primary Care Nurse Practitioner: Definition to come...
Other primary care nurse practitioner providers in Central Point
About NPI 1760960462
Sid Christian Keomanivong's National Provider Identifier is 1760960462, issued on Aug 3, 2018. The primary taxonomy on file is Primary Care Nurse Practitioner (363LP2300X), and the practice location is in Central Point, OR. The record was last updated on Oct 8, 2019.