Healthcare Provider Details

I. General information

NPI: 1578657656
Provider Name (Legal Business Name): IRENE P VETTO ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 SE STRATUS AVE SUITE A
MCMINNVILLE OR
97128-6255
US

IV. Provider business mailing address

875 OAK ST SE SUITE 4030
SALEM OR
97301-3975
US

V. Phone/Fax

Practice location:
  • Phone: 503-435-6590
  • Fax: 503-435-6591
Mailing address:
  • Phone: 503-561-6444
  • Fax: 503-561-6440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number091007206N3
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: