Healthcare Provider Details

I. General information

NPI: 1851313480
Provider Name (Legal Business Name): WOMENS HEALTHCARE PROFESSIONALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 WELCH ST
SILVERTON OR
97381
US

IV. Provider business mailing address

PO BOX 337
SILVERTON OR
97381
US

V. Phone/Fax

Practice location:
  • Phone: 503-873-8853
  • Fax: 503-873-8355
Mailing address:
  • Phone: 503-873-8853
  • Fax: 503-873-8355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: DENIS JON DALISKY
Title or Position: OWNER
Credential: MD
Phone: 503-873-8853