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General NPI Number Information
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NPI Number | 1598256281
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Entity Type | Organization
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Legal Business Name | OREGON WELLNESS NETWORK LLC
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Dates
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Enumeration Date | 05/29/2018
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 3410 CHERRY AVE NE
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City | KEIZER
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State | OR
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Zip | 97303
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Country | US
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Telephone | 503-304-3655
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Fax |
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Provider Business Mailing Address
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Address Line | 3410 CHERRY AVE NE
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City | KEIZER
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State | OR
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Zip | 97303-4924
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Country | US
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Telephone | 503-304-3408
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | LAVINIA GOTO
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Credential |
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Telephone | 503-304-3408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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