Healthcare Provider Details

I. General information

NPI: 1992758643
Provider Name (Legal Business Name): ELEANOR ZAWADA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

974 N CASCADE DR
WOODBURN OR
97071-3141
US

IV. Provider business mailing address

PO BOX 278
WOODBURN OR
97071-0278
US

V. Phone/Fax

Practice location:
  • Phone: 503-982-0403
  • Fax: 503-981-2249
Mailing address:
  • Phone: 971-983-5260
  • Fax: 971-983-5326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: