Healthcare Provider Details

I. General information

NPI: 1205355740
Provider Name (Legal Business Name): HEIDI MARIE SEMPLE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2017
Last Update Date: 02/23/2024
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PEACEHEALTH SURGICAL SPECIALTIES 3355 RIVERBEND DR STE 300
SPRINGFIELD OR
97477-8800
US

IV. Provider business mailing address

PEACEHEALTH SURGICAL SPECIALTIES 3355 RIVERBEND DR STE 300
SPRINGFIELD OR
97477-8800
US

V. Phone/Fax

Practice location:
  • Phone: 541-222-8333
  • Fax: 541-222-8320
Mailing address:
  • Phone: 541-222-8333
  • Fax: 541-222-8320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201707603NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: