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General NPI Number Information
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NPI Number | 1033285713
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Entity Type | Individual
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Provider Name | RITA HERLONG PMHNP
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Gender | Female
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 05/20/2016
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Provider Practice Location Address
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Address Line | 4035 12TH STREET CUTOFF SUIT120
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City | SALEM
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State | OR
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Zip | 97302-1764
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Country | US
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Telephone | 503-363-4506
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Fax | 503-362-3607
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Provider Business Mailing Address
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Address Line | PO BOX 5785
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City | SALEM
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State | OR
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Zip | 97304-0785
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Country | US
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Telephone | 503-363-4506
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Fax | 503-362-3607
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 000033561N6
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License Number State | OR
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