Healthcare Provider Details

I. General information

NPI: 1649082678
Provider Name (Legal Business Name): HEART OF THE VALLEY GYNECOLOGY AND SEXUAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 NW PROFESSIONAL DR STE 202
CORVALLIS OR
97330-3892
US

IV. Provider business mailing address

1120 NW ALDER CREEK DR
CORVALLIS OR
97330-9102
US

V. Phone/Fax

Practice location:
  • Phone: 541-919-5778
  • Fax: 541-229-5202
Mailing address:
  • Phone: 541-602-1165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: DR. SUSAN J WEGELT HEINZ
Title or Position: CEO
Credential: DNP, CNM
Phone: 541-602-1165