Healthcare Provider Details

I. General information

NPI: 1831433887
Provider Name (Legal Business Name): VICKI J MOSBY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1980 WASHINGTON ST
EUGENE OR
97405-2664
US

IV. Provider business mailing address

1980 WASHINGTON ST
EUGENE OR
97405-2664
US

V. Phone/Fax

Practice location:
  • Phone: 541-517-5309
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number089003226RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: