Healthcare Provider Details

I. General information

NPI: 1255379566
Provider Name (Legal Business Name): WILLAMETTE COMMUNITY HEALTH SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 SUZANNE WAY, #200
EUGENE OR
97408-7619
US

IV. Provider business mailing address

2650 SUZANNE WAY, #200
EUGENE OR
97408-7619
US

V. Phone/Fax

Practice location:
  • Phone: 541-228-3008
  • Fax: 541-228-3180
Mailing address:
  • Phone: 541-228-3008
  • Fax: 541-228-3180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CHERYL A BOYUM
Title or Position: CEO
Credential:
Phone: 541-228-3002