Healthcare Provider Details

I. General information

NPI: 1710123427
Provider Name (Legal Business Name): MANON GABRIELLE VRAIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2008
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 CHAD DR
EUGENE OR
97408-7428
US

IV. Provider business mailing address

3355 CHAD DR
EUGENE OR
97408-7428
US

V. Phone/Fax

Practice location:
  • Phone: 541-607-7459
  • Fax: 541-607-7573
Mailing address:
  • Phone: 541-607-7459
  • Fax: 760-967-4450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number74533
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95021318
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number724402
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: