Healthcare Provider Details

I. General information

NPI: 1467035147
Provider Name (Legal Business Name): SRI ABIRAMI SELVAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1077 GATEWAY LOOP
SPRINGFIELD OR
97477-1114
US

IV. Provider business mailing address

1077 GATEWAY LOOP
SPRINGFIELD OR
97477-1114
US

V. Phone/Fax

Practice location:
  • Phone: 541-485-6478
  • Fax: 541-868-9606
Mailing address:
  • Phone: 541-485-6478
  • Fax: 541-868-9606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPG227272
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD231263
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: