Healthcare Provider Details

I. General information

NPI: 1154251627
Provider Name (Legal Business Name): WYNEMA LYNN THURMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W SPERRY ST
HEPPNER OR
97836
US

IV. Provider business mailing address

46523 MISSION RD UNIT 6
PENDLETON OR
97801-6038
US

V. Phone/Fax

Practice location:
  • Phone: 541-676-9161
  • Fax:
Mailing address:
  • Phone: 541-276-6207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number34-20513
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: