Healthcare Provider Details

I. General information

NPI: 1639688674
Provider Name (Legal Business Name): AMY TREZONA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2017
Last Update Date: 09/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 CHAMBERS ST
EUGENE OR
97402-3655
US

IV. Provider business mailing address

518 COVEY LN
EUGENE OR
97401-8848
US

V. Phone/Fax

Practice location:
  • Phone: 541-682-3550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

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: