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General NPI Number Information
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NPI Number | 1043176423
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Entity Type | Individual
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Provider Name | ANGELINE DELORIS POIRIER THW
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Gender | Female
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Dates
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Enumeration Date | 12/30/2025
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 200 GWEE SHUT RD
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City | SILETZ
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State | OR
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Zip | 97380-2036
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Country | US
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Telephone | 541-444-1030
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 320
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City | SILETZ
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State | OR
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Zip | 97380-0320
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Country | US
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Telephone | 541-444-1030
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Fax |
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 115240
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License Number State | OR
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