Healthcare Provider Details

I. General information

NPI: 1053952648
Provider Name (Legal Business Name): CLAIRE MARIE EXUM PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2019
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 S 52ND PL
SPRINGFIELD OR
97478-6210
US

IV. Provider business mailing address

PO BOX 1517
PENDLETON OR
97801-0410
US

V. Phone/Fax

Practice location:
  • Phone: 541-746-1166
  • Fax:
Mailing address:
  • Phone: 877-708-1119
  • Fax: 541-278-8349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA209234
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: