Healthcare Provider Details

I. General information

NPI: 1376281816
Provider Name (Legal Business Name): DAVID MAYFIELD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2191 MARION ST
NORTH BEND OR
97459-2314
US

IV. Provider business mailing address

2191 MARION ST
NORTH BEND OR
97459-2314
US

V. Phone/Fax

Practice location:
  • Phone: 541-756-8002
  • Fax:
Mailing address:
  • Phone: 541-756-8002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number653459
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: