Healthcare Provider Details

I. General information

NPI: 1194619775
Provider Name (Legal Business Name): MARSHALL HARVEY RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 NW SAMARITAN DR
CORVALLIS OR
97330-5472
US

IV. Provider business mailing address

25160 E BROADWAY AVE APT 3D
VENETA OR
97487-7708
US

V. Phone/Fax

Practice location:
  • Phone: 541-228-2989
  • Fax:
Mailing address:
  • Phone: 541-221-7165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number10011027
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: