Healthcare Provider Details

I. General information

NPI: 1952180523
Provider Name (Legal Business Name): VIVIANNE SANCHEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 W B ST STE O
SPRINGFIELD OR
97477-4593
US

IV. Provider business mailing address

188 W B ST STE O
SPRINGFIELD OR
97477-4593
US

V. Phone/Fax

Practice location:
  • Phone: 458-234-6800
  • Fax: 458-200-4221
Mailing address:
  • Phone: 458-234-6800
  • Fax: 458-200-4221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number202204272RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: