Healthcare Provider Details

I. General information

NPI: 1790603520
Provider Name (Legal Business Name): RACHEL RUTH BROCKER LANGFORD BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 E 11TH AVE
EUGENE OR
97401-3746
US

IV. Provider business mailing address

1236 MELVINA WAY
EUGENE OR
97404-2843
US

V. Phone/Fax

Practice location:
  • Phone: 458-205-7013
  • Fax:
Mailing address:
  • Phone: 563-940-0023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number10033071
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: