Healthcare Provider Details

I. General information

NPI: 1083178180
Provider Name (Legal Business Name): NORTHWEST HEALTH PARTNERS NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 RIVERBEND DR STE 430
SPRINGFIELD OR
97477-8800
US

IV. Provider business mailing address

3355 RIVERBEND DR STE 430
SPRINGFIELD OR
97477-8800
US

V. Phone/Fax

Practice location:
  • Phone: 541-868-9393
  • Fax:
Mailing address:
  • Phone: 541-868-9396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: DAVE DEVALK
Title or Position: CEO
Credential:
Phone: 541-868-9393