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General NPI Number Information
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NPI Number | 1841935848
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Entity Type | Individual
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Provider Name | TANYA FRESQUEZ FNP-C
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Gender | Female
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Dates
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Enumeration Date | 05/03/2022
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Last Update Date | 05/03/2022
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Provider Practice Location Address
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Address Line | 147 S 52ND PL
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City | SPRINGFIELD
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State | OR
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Zip | 97478-6210
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Country | US
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Telephone | 541-746-1166
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Fax |
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Provider Business Mailing Address
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Address Line | 5309 OLYMPIC CIR
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City | EUGENE
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State | OR
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Zip | 97402-6495
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Country | US
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Telephone | 541-279-4312
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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 | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 201393834RN
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | PENDING
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License Number State | OR
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