Individual
MYRA DELINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1515 VILLAGE DR STE 100, COTTAGE GROVE, OR 97424-9700
(541) 767-5200
(541) 767-5288
Mailing address
3614 EMERALD ST, EUGENE, OR 97405-4329
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
201808281RN
OR
363L00000X
Nurse Practitioner
Primary
201809683NP-PP
OR
Other
Enumeration date
10/09/2018
Last updated
10/18/2019
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