Healthcare Provider Details

I. General information

NPI: 1548852023
Provider Name (Legal Business Name): MIRIAM D WHAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2021
Last Update Date: 02/06/2021
Certification Date: 02/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 N ALBANY RD NW
ALBANY OR
97321-1324
US

IV. Provider business mailing address

910 N ALBANY RD NW
ALBANY OR
97321-1324
US

V. Phone/Fax

Practice location:
  • Phone: 503-719-3875
  • Fax:
Mailing address:
  • Phone: 503-719-3875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number201905110RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: