Individual
RILEY HACKLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
425 N SANTIAM HWY, LEBANON, OR 97355-4361
(541) 451-6960
Mailing address
PO BOX 1189, CORVALLIS, OR 97339-1189
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
PA222009
OR
363A00000X
Physician Assistant
Primary
PA222009
OR
Other
Enumeration date
09/20/2024
Last updated
11/25/2024
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