Healthcare Provider Details

I. General information

NPI: 1720344864
Provider Name (Legal Business Name): JOSH SIZEMORE RN, MN, PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 NW GRANT AVE
CORVALLIS OR
97330-4366
US

IV. Provider business mailing address

2075 NW GRANT AVE
CORVALLIS OR
97330-4366
US

V. Phone/Fax

Practice location:
  • Phone: 541-368-3152
  • Fax: 855-279-0612
Mailing address:
  • Phone: 541-368-3152
  • Fax: 855-279-0612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number201043002RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number201250124NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: