Healthcare Provider Details

I. General information

NPI: 1013854249
Provider Name (Legal Business Name): HEIDI JEAN YAICH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALIA YAICH RN

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 SW 3RD ST STE 304
CORVALLIS OR
97333-4652
US

IV. Provider business mailing address

33684 MARYS RIVER ESTATES RD
PHILOMATH OR
97370-9021
US

V. Phone/Fax

Practice location:
  • Phone: 541-286-8558
  • Fax:
Mailing address:
  • Phone: 541-286-8558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201603096RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: