Healthcare Provider Details

I. General information

NPI: 1841400900
Provider Name (Legal Business Name): HOLLY LYN RISCH RN,IBCLC,RLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3680 NW SAMARITAN DR
CORVALLIS OR
97330-3737
US

IV. Provider business mailing address

5638 NW FAIR OAKS DR
CORVALLIS OR
97330-3115
US

V. Phone/Fax

Practice location:
  • Phone: 541-754-1278
  • Fax: 541-754-1512
Mailing address:
  • Phone: 541-602-6631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number200340142RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: