Healthcare Provider Details

I. General information

NPI: 1689125353
Provider Name (Legal Business Name): DEBORAH CHASE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 NW WALL ST SUITE 150
BEND OR
97703-1985
US

IV. Provider business mailing address

1340 NW WALL ST SUITE 150
BEND OR
97703-1985
US

V. Phone/Fax

Practice location:
  • Phone: 541-317-3189
  • Fax: 541-317-3190
Mailing address:
  • Phone: 541-317-3189
  • Fax: 541-317-3190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number000037543RN
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number540540
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: