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General NPI Number Information
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NPI Number | 1396117511
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Entity Type | Organization
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Legal Business Name | WESTERN OREGON SERVICE UNIT
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Dates
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Enumeration Date | 10/27/2015
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Last Update Date | 10/27/2015
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Provider Practice Location Address
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Address Line | 3750 CHEMAWA RD NE
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City | SALEM
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State | OR
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Zip | 97305-1119
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Country | US
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Telephone | 503-304-7600
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Fax |
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Provider Business Mailing Address
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Address Line | 11815 NE 60TH AVE
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City | VANCOUVER
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State | WA
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Zip | 98686-4585
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Country | US
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Telephone | 405-439-3873
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. LAURA HERBISON
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Credential | RN, BSN
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Telephone | 503-304-7642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP0904X
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Taxonomy Name | Federal Public Health Clinic/Center
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License Number | R0067049
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License Number State | OK
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