Healthcare Provider Details

I. General information

NPI: 1992361323
Provider Name (Legal Business Name): VALENTINA BRICHUK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2019
Last Update Date: 05/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1098 CLEARVIEW AVE NE
KEIZER OR
97303-4870
US

IV. Provider business mailing address

1098 CLEARVIEW AVE NE
KEIZER OR
97303-4870
US

V. Phone/Fax

Practice location:
  • Phone: 503-580-4963
  • Fax: 503-399-0891
Mailing address:
  • Phone: 503-580-4963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
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: