Healthcare Provider Details

I. General information

NPI: 1598035925
Provider Name (Legal Business Name): SHARA MAE SALVERDA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2012
Last Update Date: 04/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NW 11TH ST SUITE E-15
HERMISTON OR
97838-8602
US

IV. Provider business mailing address

600 NW 11TH ST SUITE E-15
HERMISTON OR
97838-8602
US

V. Phone/Fax

Practice location:
  • Phone: 541-567-6434
  • Fax: 541-567-6019
Mailing address:
  • Phone: 541-567-6434
  • Fax: 541-567-6019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201150189NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: