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General NPI Number Information
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NPI Number | 1790905859
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Entity Type | Organization
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Legal Business Name | UMPQUA VALLEY WOMENS CARE PC
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Dates
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Enumeration Date | 04/30/2007
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Last Update Date | 03/13/2009
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Provider Practice Location Address
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Address Line | 2423 NW TROOST ST
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City | ROSEBURG
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State | OR
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Zip | 97471-1706
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Country | US
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Telephone | 541-464-0788
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Fax | 541-464-0789
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Provider Business Mailing Address
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Address Line | 2423 NW TROOST STREET
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City | ROSEBURG
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State | OR
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Zip | 97470
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Country | US
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Telephone | 541-464-0788
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Fax | 541-464-0789
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Authorized Official
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Title or Position | COO/ CFO
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Name | MR. STEVEN JOEL VANNUCCI
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Credential |
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Telephone | 541-464-0788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | DO21702
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License Number State | OR
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