Healthcare Provider Details

I. General information

NPI: 1548644867
Provider Name (Legal Business Name): KATRINA SIMPSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 07/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 NW BEAVER ST
PRINEVILLE OR
97754-1802
US

IV. Provider business mailing address

375 NW BEAVER ST
PRINEVILLE OR
97754-1802
US

V. Phone/Fax

Practice location:
  • Phone: 541-447-5165
  • Fax: 541-447-3093
Mailing address:
  • Phone: 541-447-5165
  • Fax: 541-447-3093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number201504522RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: