Healthcare Provider Details

I. General information

NPI: 1407100316
Provider Name (Legal Business Name): ROXANNE IRENE ELLINGBOE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 4TH AVE SW
ALBANY OR
97321-2338
US

IV. Provider business mailing address

315 4TH AVE SW P.O. BOX 100
ALBANY OR
97321-2338
US

V. Phone/Fax

Practice location:
  • Phone: 541-967-3888
  • Fax:
Mailing address:
  • Phone: 541-967-3888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number085075111RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: