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1174 Cornucopia St Nw Ste 240 Salem OR 97304 | |
| (971) 301-4411 | |
| (971) 999-7006 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1174 Cornucopia St Nw Ste 240, Salem, Oregon |
| Authorized Official Name and Position | Aubrey Lynn Harding (OWNER) |
| Authorized Official Contact | 9713014411 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1174 Cornucopia St Nw Ste 240 Salem OR 97304-3193 Ph: (971) 301-4411 | 1174 Cornucopia St Nw Ste 240 Salem OR 97304 Ph: (971) 301-4411 |
| NPI Number | 1760998355 |
|---|---|
| Provider Enumeration Date | 12/19/2017 |
| Last Update Date | 01/07/2019 |
| Medicare PECOS PAC ID | 1355684937 |
|---|---|
| Medicare Enrollment ID | O20190522002581 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760998355 | NPI | - | NPPES |
| 500694138 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 3012 (Oregon) | Primary |
| Provider Name | Jennifer E Drayton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982030458 PECOS PAC ID: 8325277049 Enrollment ID: I20140129000905 |
| Provider Name | Molly Rodden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144620295 PECOS PAC ID: 4880916972 Enrollment ID: I20171218001806 |
| Provider Name | Melissa Renee Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437636065 PECOS PAC ID: 3971848623 Enrollment ID: I20181227001190 |
| Provider Name | Emily R Charlton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407330889 PECOS PAC ID: 0941548663 Enrollment ID: I20190205001346 |
| Provider Name | Aaron Erez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184018079 PECOS PAC ID: 9638402217 Enrollment ID: I20190613001828 |
| Provider Name | Dale Lachance |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568937563 PECOS PAC ID: 3274887591 Enrollment ID: I20210604001657 |
| Provider Name | Wanda Hill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316928708 PECOS PAC ID: 0941201925 Enrollment ID: I20210902002986 |
| Provider Name | Yesenia Reyes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356844674 PECOS PAC ID: 5395084453 Enrollment ID: I20220916001374 |
| Provider Name | Patrick Testa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588303937 PECOS PAC ID: 9739567280 Enrollment ID: I20230719002231 |
| Provider Name | David John Ramsay |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1447927314 PECOS PAC ID: 6709317480 Enrollment ID: I20241004002861 |
| Provider Name | Faiza Haque |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982249728 PECOS PAC ID: 9133539802 Enrollment ID: I20241115001798 |
| Provider Name | Sreshtha Singh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174214985 PECOS PAC ID: 6507229846 Enrollment ID: I20241203004632 |
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