Healthcare Provider Details

I. General information

NPI: 1790905859
Provider Name (Legal Business Name): UMPQUA VALLEY WOMENS CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 03/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2423 NW TROOST ST
ROSEBURG OR
97471-1706
US

IV. Provider business mailing address

2423 NW TROOST STREET
ROSEBURG OR
97470
US

V. Phone/Fax

Practice location:
  • Phone: 541-464-0788
  • Fax: 541-464-0789
Mailing address:
  • Phone: 541-464-0788
  • Fax: 541-464-0789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberDO21702
License Number StateOR

VIII. Authorized Official

Name: MR. STEVEN JOEL VANNUCCI
Title or Position: COO/ CFO
Credential:
Phone: 541-464-0788