Individual
HALEY ITEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
432 W 11TH AVE, EUGENE, OR 97401-3451
(541) 662-4464
Mailing address
432 W 11TH AVE, EUGENE, OR 97401-3451
(541) 662-4464
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
201608628LPN
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1689053688
—
OR
Enumeration date
02/11/2022
Last updated
02/11/2022
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