Healthcare Provider Details

I. General information

NPI: 1841211240
Provider Name (Legal Business Name): CHRISTINE M DODSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2073 OLYMPIC STREET
SPRINGFIELD OR
97477-3413
US

IV. Provider business mailing address

2073 OLYMPIC STREET
SPRINGFIELD OR
97477-3413
US

V. Phone/Fax

Practice location:
  • Phone: 541-682-3550
  • Fax: 541-682-3551
Mailing address:
  • Phone: 541-682-3550
  • Fax: 541-682-3551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number087006549RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: