Basic Information
Provider Information
NPI: 1760079875
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DEARING
FirstName: MADELYN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1879 M ST APT 14
Address2:  
City: SPRINGFIELD
State: OR
PostalCode: 974777819
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 260 E 11TH AVE
Address2:  
City: EUGENE
State: OR
PostalCode: 974013247
CountryCode: US
TelephoneNumber: 5414844428
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/22/2020
LastUpdateDate: 12/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/22/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
175T00000X ORY    

No ID Information.


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