Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 202006410NP-PP | OR |
NPI | 1003439670 |
---|---|
Provider Name | Elizabeth Anne Varley |
First Address | Corvallis, OR 97339-1193 |
Second Address | Lebanon, OR 97355-2875 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2020 |
Last Update Date | 19/07/2021 |