Healthcare Provider Details

I. General information

NPI: 1891087110
Provider Name (Legal Business Name): RORI LEE HARTZELL DNP / FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 08/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 NE NORTON LN.
MCMINNVILLE OR
97128
US

IV. Provider business mailing address

254 NE NORTON LN.
MCMINNVILLE OR
97128
US

V. Phone/Fax

Practice location:
  • Phone: 503-472-6161
  • Fax: 503-434-6290
Mailing address:
  • Phone: 503-472-6161
  • Fax: 503-434-6290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number201250080NP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201250080NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: