Healthcare Provider Details

I. General information

NPI: 1205572112
Provider Name (Legal Business Name): APRIL DIVINEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2022
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 NE FORD ST
MCMINNVILLE OR
97128-4608
US

IV. Provider business mailing address

412 NE FORD ST
MCMINNVILLE OR
97128-4608
US

V. Phone/Fax

Practice location:
  • Phone: 971-312-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number201808085RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: