Healthcare Provider Details

I. General information

NPI: 1609766054
Provider Name (Legal Business Name): CINDY LEE RASAVAGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 INTERNATIONAL WAY
SPRINGFIELD OR
97477-1047
US

IV. Provider business mailing address

26023 GIRL SCOUT RD
VENETA OR
97487-9653
US

V. Phone/Fax

Practice location:
  • Phone: 458-205-7300
  • Fax:
Mailing address:
  • Phone: 541-913-4763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number096000478RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10047405
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: