Healthcare Provider Details

I. General information

NPI: 1346682002
Provider Name (Legal Business Name): DARREL C HAND FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2013
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 NW GARDEN VALLEY BLVD
ROSEBURG OR
97471-6523
US

IV. Provider business mailing address

300 GARDEN GROVE DR
ROSEBURG OR
97471-9511
US

V. Phone/Fax

Practice location:
  • Phone: 541-440-1000
  • Fax: 541-440-1208
Mailing address:
  • Phone: 541-673-1424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20190817NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: