Healthcare Provider Details

I. General information

NPI: 1003239666
Provider Name (Legal Business Name): KIM SCHLESSINGER ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2014
Last Update Date: 01/31/2014
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: 541-768-6687
  • Fax: 541-768-5424
Mailing address:
  • Phone: 541-768-6687
  • Fax: 541-768-5424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number092006710N3 ANP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: