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NPI Code Detail

MEDICARE: BILLY JUNIOR NESIBA JR. LPN

MEDICARE: BILLY JUNIOR NESIBA JR. LPN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical Nurse201910360LPNOR

General Provider Information

NPI Number : 1538775259
Entity Type Code : Individual
Provider Name (Legal Business Name) : BILLY JUNIOR NESIBA JR. LPN
Provider Business Mailing Address
First Line : 5519 CARDIFF ST
Second Line :
City : EUGENE
State : OR
Zip : 97402-7549
Country : US
Telephone Number : 308-379-0213
Fax Number :
Provider Business Practice Location Address
First Line : 1201 MCLEAN BLVD
Second Line :
City : EUGENE
State : OR
Zip : 97405-1979
Country : US
Telephone Number : 541-683-2155
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/17/2020
Last Update Date : 09/17/2020

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