Healthcare Provider Details

I. General information

NPI: 1720999634
Provider Name (Legal Business Name): JAELYN HUA CHAO CREBBIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HILYARD ST
EUGENE OR
97401-8122
US

IV. Provider business mailing address

2801 MIRAMONTI DR
EUGENE OR
97405-1951
US

V. Phone/Fax

Practice location:
  • Phone: 541-685-1794
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberWDL36ZNC223B
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: