Provider Demographics
NPI:1053638536
Name:MA, HAIYUN ELLINA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:HAIYUN
Middle Name:ELLINA
Last Name:MA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 W 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97448-1313
Mailing Address - Country:US
Mailing Address - Phone:541-998-6750
Mailing Address - Fax:541-998-1247
Practice Address - Street 1:355 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:OR
Practice Address - Zip Code:97448-1313
Practice Address - Country:US
Practice Address - Phone:541-998-6750
Practice Address - Fax:541-998-1247
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200850172NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily