Healthcare Provider Details

I. General information

NPI: 1518274414
Provider Name (Legal Business Name): MICHELLE DAVILA FNP, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2010
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3377 RIVERBEND DR STE 420
SPRINGFIELD OR
97477-8807
US

IV. Provider business mailing address

3377 RIVERBEND DR STE 420
SPRINGFIELD OR
97477-8807
US

V. Phone/Fax

Practice location:
  • Phone: 541-222-8500
  • Fax: 541-222-6435
Mailing address:
  • Phone: 541-222-8500
  • Fax: 541-222-6435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201250099NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: