Healthcare Provider Details

I. General information

NPI: 1710332986
Provider Name (Legal Business Name): ALANNA HANNEGRAF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HILYARD ST STE 230
EUGENE OR
97401-8122
US

IV. Provider business mailing address

2946 NW ANGELICA PL
CORVALLIS OR
97330-3624
US

V. Phone/Fax

Practice location:
  • Phone: 458-205-6011
  • Fax: 458-205-6071
Mailing address:
  • Phone: 218-391-3756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO200535
License Number StateOR

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: