Healthcare Provider Details

I. General information

NPI: 1659018836
Provider Name (Legal Business Name): NANCY SUZANNE SCHRIVER REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
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: 541-756-7503
Mailing address:
  • Phone: 541-756-8002
  • Fax: 541-756-7503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number200842014
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: