Healthcare Provider Details

I. General information

NPI: 1720447618
Provider Name (Legal Business Name): DEBRA NEVILLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2016
Last Update Date: 12/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W MAIN ST
MEDFORD OR
97501-2756
US

IV. Provider business mailing address

300 W. MAIN ST
MEDFORD OR
97501
US

V. Phone/Fax

Practice location:
  • Phone: 541-772-1777
  • Fax: 541-734-2410
Mailing address:
  • Phone: 541-772-1777
  • Fax: 541-734-2410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: