Healthcare Provider Details

I. General information

NPI: 1699443473
Provider Name (Legal Business Name): ELLEN LORRAINE SYVERSEN NTP, RWS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2021
Last Update Date: 09/05/2021
Certification Date: 09/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 TAYLOR ST
EUGENE OR
97405-2214
US

IV. Provider business mailing address

2710 TAYLOR ST
EUGENE OR
97405-2214
US

V. Phone/Fax

Practice location:
  • Phone: 541-912-8624
  • Fax:
Mailing address:
  • Phone: 541-912-8624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number801
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: