Healthcare Provider Details

I. General information

NPI: 1073163408
Provider Name (Legal Business Name): REBECCA RILEY MOYES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2019
Last Update Date: 08/23/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 SW MADISON AVE STE 209
CORVALLIS OR
97333-4757
US

IV. Provider business mailing address

257 SW MADISON AVE STE 209
CORVALLIS OR
97333-4757
US

V. Phone/Fax

Practice location:
  • Phone: 971-368-1045
  • Fax: 971-233-6398
Mailing address:
  • Phone: 971-368-1045
  • Fax: 971-233-6398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number202108941NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: