Healthcare Provider Details

I. General information

NPI: 1598059305
Provider Name (Legal Business Name): GLENN ERIC YAUNEY RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10313 SW 69TH AVE
TIGARD OR
97223-9103
US

IV. Provider business mailing address

10313 SW 69TH AVE
TIGARD OR
97223-9103
US

V. Phone/Fax

Practice location:
  • Phone: 503-726-3697
  • Fax:
Mailing address:
  • Phone: 503-726-3697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number200040599RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: