Basic Information
| Provider Information | |||||||||
| NPI: | 1831437946 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEEDS | ||||||||
| FirstName: | TERENCE | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 MULLINS DR | ||||||||
| Address2: | STE A-1 | ||||||||
| City: | LEBANON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973553982 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414516920 | ||||||||
| FaxNumber: | 5414516924 | ||||||||
| Practice Location | |||||||||
| Address1: | 530 NW 27TH ST | ||||||||
| Address2: | |||||||||
| City: | CORVALLIS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973305223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417666835 | ||||||||
| FaxNumber: | 5417666186 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2013 | ||||||||
| LastUpdateDate: | 01/24/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 201240251RN | OR | Y | Nursing Service Providers | Registered Nurse |
No ID Information.