Healthcare Provider Details

I. General information

NPI: 1740086982
Provider Name (Legal Business Name): MIJUNG HUH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3377 RIVERBEND DR
SPRINGFIELD OR
97477-8803
US

IV. Provider business mailing address

3377 RIVERBEND DR
SPRINGFIELD OR
97477-8803
US

V. Phone/Fax

Practice location:
  • Phone: 541-222-8400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number123456
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: