Healthcare Provider Details

I. General information

NPI: 1811775976
Provider Name (Legal Business Name): IRINA VESOLOWSKI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 W 3RD AVE
JUNCTION CITY OR
97448-1313
US

IV. Provider business mailing address

355 W 3RD AVE
JUNCTION CITY OR
97448-1313
US

V. Phone/Fax

Practice location:
  • Phone: 541-640-7625
  • Fax: 541-998-8270
Mailing address:
  • Phone: 541-640-7625
  • Fax: 541-998-8270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10015616
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11025518
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: