Healthcare Provider Details

I. General information

NPI: 1356498554
Provider Name (Legal Business Name): MARTA L BADALICH RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 SUNSET VW
EUGENE OR
97405-7015
US

IV. Provider business mailing address

4050 SUNSET VW
EUGENE OR
97405-7015
US

V. Phone/Fax

Practice location:
  • Phone: 541-510-2465
  • Fax:
Mailing address:
  • Phone: 541-510-2465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: