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General NPI Number Information
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NPI Number | 1609666064
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Entity Type | Organization
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Legal Business Name | PNW WOUND CARE
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Dates
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Enumeration Date | 05/08/2025
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 3810 PACIFIC BLVD SW
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City | ALBANY
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State | OR
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Zip | 97321-7752
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Country | US
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Telephone | 541-390-3858
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Fax | 541-666-3752
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Provider Business Mailing Address
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Address Line | 3810 PACIFIC BLVD SW
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City | ALBANY
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State | OR
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Zip | 97321-7752
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Country | US
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Telephone | 541-390-3858
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Fax | 541-666-3752
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Authorized Official
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Title or Position | OWNER
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Name | BRANDY TOLLIVER
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Credential | NP
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Telephone | 541-390-3858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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