Healthcare Provider Details

I. General information

NPI: 1104458652
Provider Name (Legal Business Name): JORGE I DELUNA RN, BSN.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

944 68TH ST
SPRINGFIELD OR
97478-2108
US

IV. Provider business mailing address

944 68TH ST
SPRINGFIELD OR
97478-2108
US

V. Phone/Fax

Practice location:
  • Phone: 541-915-6391
  • Fax:
Mailing address:
  • Phone: 541-915-6391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number098007236
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: