Healthcare Provider Details

I. General information

NPI: 1336620061
Provider Name (Legal Business Name): DANIELLE TIFFANY NEET
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 INTERNATIONAL WAY STE 200
SPRINGFIELD OR
97477-7006
US

IV. Provider business mailing address

2073 OLYMPIC ST
SPRINGFIELD OR
97477-3413
US

V. Phone/Fax

Practice location:
  • Phone: 541-844-0151
  • Fax: 541-636-2722
Mailing address:
  • Phone: 503-753-5759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10059197
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number201230117LPN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: