Basic Information
| Provider Information | |||||||||
| NPI: | 1962478867 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | O'REILLY | ||||||||
| FirstName: | REDEEM | ||||||||
| MiddleName: | FALLER | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NURSE PRACTITONER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 404 | ||||||||
| Address2: | |||||||||
| City: | AUMSVILLE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973250404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037491462 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 530 NW 27TH ST | ||||||||
| Address2: | |||||||||
| City: | CORVALLIS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973305223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417666138 | ||||||||
| FaxNumber: | 5417666186 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2006 | ||||||||
| LastUpdateDate: | 08/29/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | 000026912N7 WHCNP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.