Healthcare Provider Details

I. General information

NPI: 1023360732
Provider Name (Legal Business Name): ANNA SEKAVEC RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2012
Last Update Date: 10/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 SW MEMORIAL PL
CORVALLIS OR
97331-8667
US

IV. Provider business mailing address

108 SW MEMORIAL PL
CORVALLIS OR
97331-8667
US

V. Phone/Fax

Practice location:
  • Phone: 541-737-9355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201141700RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: