Healthcare Provider Details

I. General information

NPI: 1831168756
Provider Name (Legal Business Name): ELIZABETH P CHURCHILL PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HILYARD ST
EUGENE OR
97401-8122
US

IV. Provider business mailing address

PO BOX 24410
EUGENE OR
97402-0451
US

V. Phone/Fax

Practice location:
  • Phone: 541-744-0828
  • Fax: 541-687-6214
Mailing address:
  • Phone: 541-984-4301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number76036597N6
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: