Healthcare Provider Details

I. General information

NPI: 1336169911
Provider Name (Legal Business Name): VIRGINIA LOIS CAPAN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 SW JACKSON PARK BLVD OREGON HEALTH & SCIENCE UNIVERSITY
PORTLAND OR
97239
US

IV. Provider business mailing address

3193 SE MIDVALE DR
CORVALLIS OR
97333-3104
US

V. Phone/Fax

Practice location:
  • Phone: 503-418-0980
  • Fax:
Mailing address:
  • Phone: 541-207-2286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: