Basic Information
| Provider Information | |||||||||
| NPI: | 1851313480 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WOMENS HEALTHCARE PROFESSIONALS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 337 | ||||||||
| Address2: | |||||||||
| City: | SILVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038738853 | ||||||||
| FaxNumber: | 5038738355 | ||||||||
| Practice Location | |||||||||
| Address1: | 406 WELCH ST | ||||||||
| Address2: | |||||||||
| City: | SILVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038738853 | ||||||||
| FaxNumber: | 5038738355 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 11/15/2012 | ||||||||
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| AuthorizedOfficialLastName: | DALISKY | ||||||||
| AuthorizedOfficialFirstName: | DENIS | ||||||||
| AuthorizedOfficialMiddleName: | JON | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5038738853 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 207V00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 170108 | 05 | OR | MEDICAID |