Healthcare Provider Details

I. General information

NPI: 1790930238
Provider Name (Legal Business Name): SANDRA LEE MORRIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SANDRA LEE ROSELAND

II. Dates (important events)

Enumeration Date: 11/25/2008
Last Update Date: 11/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 SE MARION AVE
CORVALLIS OR
97333-2039
US

IV. Provider business mailing address

945 SE MARION AVE
CORVALLIS OR
97333-2039
US

V. Phone/Fax

Practice location:
  • Phone: 541-753-8077
  • Fax:
Mailing address:
  • Phone: 541-753-8077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number088000299RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: