| Organization Name: | CANBY HEALTHCARE CLINIC LLC |
| NPI Number: | 1083915508 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KAREN ELIZABETH SHAW (STAFF ADULT NURSE PRACTITIONER) |
| Mailing Address: | 703 Se 1st Ave Canby |
| State: | OR US |
| Postal Code: | 970133849 |
| Phone Number: | 5032667686 |
| Fax Number: | 5032667382 |
| NPI Enumeration Date: | 11/15/2010 |
| NPI Last Update Date: | 11/15/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 085074804 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |