Healthcare Provider Details

I. General information

NPI: 1770780983
Provider Name (Legal Business Name): DALE HITCHCOCK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 EAST LINCOLN RD.
WOODBURN OR
97071-5534
US

IV. Provider business mailing address

325 BRANDYWINE CT
WOODBURN OR
97071-5534
US

V. Phone/Fax

Practice location:
  • Phone: 503-982-9300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: