Provider Demographics
NPI:1700858289
Name:OUIMETTE, MARGOT (PA)
Entity Type:Individual
Prefix:
First Name:MARGOT
Middle Name:
Last Name:OUIMETTE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 W HARVARD AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-2756
Mailing Address - Country:US
Mailing Address - Phone:541-672-7546
Mailing Address - Fax:541-957-8446
Practice Address - Street 1:1813 W HARVARD AVE STE 310
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-2756
Practice Address - Country:US
Practice Address - Phone:541-672-7546
Practice Address - Fax:541-957-8446
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLL15893363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORLL15893OtherOREGON PA LICENSE