Healthcare Provider Details

I. General information

NPI: 1053888776
Provider Name (Legal Business Name): KERI JOYCE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2018
Last Update Date: 10/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 W 7TH AVE
EUGENE OR
97401-1100
US

IV. Provider business mailing address

4114 NE ASBAHR PL
CORVALLIS OR
97330-9628
US

V. Phone/Fax

Practice location:
  • Phone: 541-682-4041
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201806418RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: