Healthcare Provider Details

I. General information

NPI: 1366216541
Provider Name (Legal Business Name): DEBORAH LYNN FELL CARLSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEBORAH LYNN FELLCARLSON

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37631 SODAVILLE CUT OFF DR
LEBANON OR
97355-9371
US

IV. Provider business mailing address

PO BOX 580
LEBANON OR
97355-0580
US

V. Phone/Fax

Practice location:
  • Phone: 541-248-0595
  • Fax:
Mailing address:
  • Phone: 541-248-0595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number096006066RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: