Healthcare Provider Details

I. General information

NPI: 1548056864
Provider Name (Legal Business Name): TEYAH HULSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 E 10TH AVE STE 450
EUGENE OR
97401-5599
US

IV. Provider business mailing address

32184 LATHAM RD
COTTAGE GROVE OR
97424-9338
US

V. Phone/Fax

Practice location:
  • Phone: 541-687-6983
  • Fax: 541-687-2063
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: