Healthcare Provider Details

I. General information

NPI: 1780148791
Provider Name (Legal Business Name): DENISE MARIE DRIVER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 07/24/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 PRINGLE REL. SE
SALEM OR
97302
US

IV. Provider business mailing address

2611 PRINGLE REL. SE
SALEM OR
97302
US

V. Phone/Fax

Practice location:
  • Phone: 503-588-5330
  • Fax:
Mailing address:
  • Phone: 503-588-5330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN10009600
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN60846497
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: