Healthcare Provider Details

I. General information

NPI: 1144642901
Provider Name (Legal Business Name): MARY PURDY PBP, BSN, RES-CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2014
Last Update Date: 05/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 S WATER ST
SILVERTON OR
97381-1641
US

IV. Provider business mailing address

700 WOODLAND DR NE
SILVERTON OR
97381-8710
US

V. Phone/Fax

Practice location:
  • Phone: 503-910-1045
  • Fax:
Mailing address:
  • Phone: 503-910-1045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number099000160RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number099000160RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: