Healthcare Provider Details

I. General information

NPI: 1376256719
Provider Name (Legal Business Name): HEATHER LEIGH MARCOTT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2022
Last Update Date: 12/30/2022
Certification Date: 12/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 6TH AVE SW
ALBANY OR
97321-1917
US

IV. Provider business mailing address

1023 6TH AVE SW
ALBANY OR
97321-1917
US

V. Phone/Fax

Practice location:
  • Phone: 541-926-8664
  • Fax: 833-284-2679
Mailing address:
  • Phone: 541-926-8664
  • Fax: 833-284-2679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License Number200142474RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: