Provider Demographics
NPI:1528424215
Name:AFFORDABLE INTEGRATED MEDICINE
Entity type:Organization
Organization Name:AFFORDABLE INTEGRATED MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KASKA-SUTO
Authorized Official - Suffix:
Authorized Official - Credentials:DC, FNP-C
Authorized Official - Phone:541-426-9355
Mailing Address - Street 1:610 W NORTH ST STE B
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:OR
Mailing Address - Zip Code:97828-1427
Mailing Address - Country:US
Mailing Address - Phone:541-426-9355
Mailing Address - Fax:541-426-6437
Practice Address - Street 1:610 W NORTH ST STE B
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:OR
Practice Address - Zip Code:97828-1427
Practice Address - Country:US
Practice Address - Phone:541-426-9355
Practice Address - Fax:541-426-6437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201600042NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1165930-96OtherOREGON TAX ID NUMBER