Provider Demographics
NPI:1548794092
Name:PAULINA PEAKS FAMILY HEALTHCARE
Entity Type:Organization
Organization Name:PAULINA PEAKS FAMILY HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:541-536-8060
Mailing Address - Street 1:PO BOX 3389
Mailing Address - Street 2:
Mailing Address - City:LA PINE
Mailing Address - State:OR
Mailing Address - Zip Code:97739-3389
Mailing Address - Country:US
Mailing Address - Phone:541-536-8060
Mailing Address - Fax:541-536-8795
Practice Address - Street 1:51375 HUNTINGTON RD
Practice Address - Street 2:
Practice Address - City:LA PINE
Practice Address - State:OR
Practice Address - Zip Code:97739-9625
Practice Address - Country:US
Practice Address - Phone:541-536-8060
Practice Address - Fax:541-536-8795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201400588NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty