Individual
MS. INGRID LARGE EDSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSN CFNP MED
Contact information
Practice address
315 GOODPASTURE ISLAND RD, EUGENE, OR 97401-2109
(541) 302-2977
(541) 302-6565
Mailing address
1102 HODSON LN, EUGENE, OR 97404-2944
(541) 302-2977
(541) 302-6565
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
1113222
MA
363LF0000X
Family Nurse Practitioner
Primary
200550045NPPP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200550045NPPP
OR FNP#
—
05
—
269858
—
OR
01
—
NP2194
BCBS
OR
Enumeration date
04/21/2006
Last updated
07/16/2021
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