Healthcare Provider Details

I. General information

NPI: 1629147715
Provider Name (Legal Business Name): WILLAMETTE COMMUNITY HEALTH SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 SUZANNE WAY SUITE 200
EUGENE OR
97408-7319
US

IV. Provider business mailing address

2650 SUZANNE WAY SUITE 200
EUGENE OR
97408-7319
US

V. Phone/Fax

Practice location:
  • Phone: 541-228-3020
  • Fax: 541-228-3181
Mailing address:
  • Phone: 541-228-3020
  • Fax: 541-228-3181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number
License Number StateOR

VIII. Authorized Official

Name: JACQUELYN COREY
Title or Position: DIABETES EDUCATOR
Credential: RN, CNS
Phone: 541-228-3024