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: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 COUNTRY CLUB RD
EUGENE OR
97401-6008
US

IV. Provider business mailing address

1046 6TH AVE SW
ALBANY OR
97321-1916
US

V. Phone/Fax

Practice location:
  • Phone: 541-505-8621
  • Fax:
Mailing address:
  • Phone: 541-812-4420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number200141627RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number202108941NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: