Healthcare Provider Details

I. General information

NPI: 1952698342
Provider Name (Legal Business Name): JUDITH R. ECLARINAL RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 07/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 NW SAMARITAN DR
CORVALLIS OR
97330-3737
US

IV. Provider business mailing address

3600 NW SAMARITAN DR
CORVALLIS OR
97330-3737
US

V. Phone/Fax

Practice location:
  • Phone: 541-768-5013
  • Fax:
Mailing address:
  • Phone: 541-768-5013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number200440577RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: