Healthcare Provider Details

I. General information

NPI: 1154538676
Provider Name (Legal Business Name): THEODORE PHILLIP CHASE PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 WESTGATE
PENDLETON OR
97801-9606
US

IV. Provider business mailing address

1902 SW 45TH ST
PENDLETON OR
97801-4251
US

V. Phone/Fax

Practice location:
  • Phone: 541-278-7128
  • Fax:
Mailing address:
  • Phone: 541-276-9680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: