Healthcare Provider Details

I. General information

NPI: 1841935848
Provider Name (Legal Business Name): TANYA FRESQUEZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 05/03/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 S 52ND PL
SPRINGFIELD OR
97478-6210
US

IV. Provider business mailing address

5309 OLYMPIC CIR
EUGENE OR
97402-6495
US

V. Phone/Fax

Practice location:
  • Phone: 541-746-1166
  • Fax:
Mailing address:
  • Phone: 541-279-4312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number201393834RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberPENDING
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: