Healthcare Provider Details

I. General information

NPI: 1942067947
Provider Name (Legal Business Name): ALYSSA ANN-RACHEL WEGENER APRN-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALYSSA ANN-RACHEL MALECH

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2251 E HANCOCK ST STE 103
NEWBERG OR
97132-2145
US

IV. Provider business mailing address

PO BOX 6149
ALOHA OR
97007-0149
US

V. Phone/Fax

Practice location:
  • Phone: 971-281-3000
  • Fax:
Mailing address:
  • Phone: 971-281-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10021767
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: