Healthcare Provider Details

I. General information

NPI: 1629089313
Provider Name (Legal Business Name): TRUDY ZUMBUHL EVANS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73265 CONFEDERATED WAY
PENDLETON OR
97810
US

IV. Provider business mailing address

54687 BINGHAM RD
ADAMS OR
97810-3005
US

V. Phone/Fax

Practice location:
  • Phone: 541-278-7585
  • Fax:
Mailing address:
  • Phone: 541-566-3598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number087000189N1 FNP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: