Healthcare Provider Details

I. General information

NPI: 1255573143
Provider Name (Legal Business Name): JULIE ANN IBACH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 05/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 RIVER AVE
EUGENE OR
97404-2507
US

IV. Provider business mailing address

1510 JEFFERSON ST
EUGENE OR
97402-4062
US

V. Phone/Fax

Practice location:
  • Phone: 541-607-0897
  • Fax:
Mailing address:
  • Phone: 541-222-0656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number200940693RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: