Healthcare Provider Details

I. General information

NPI: 1861663296
Provider Name (Legal Business Name): TANYA LYNNE KORRELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 E 18TH AVE STE 12
EUGENE OR
97401-4081
US

IV. Provider business mailing address

465 LOCHMOOR PL
EUGENE OR
97405-2053
US

V. Phone/Fax

Practice location:
  • Phone: 541-224-5078
  • Fax: 541-219-5859
Mailing address:
  • Phone: 480-220-0324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number38128
License Number StateAZ

VII. Legacy identifiers

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

# 1
Identifier500812142
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: