Provider Demographics
NPI:1073087334
Name:MCDOUGAL, ADORA (RN, BSN, BS)
Entity Type:Individual
Prefix:
First Name:ADORA
Middle Name:
Last Name:MCDOUGAL
Suffix:
Gender:F
Credentials:RN, BSN, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 N POLK ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-4112
Mailing Address - Country:US
Mailing Address - Phone:541-844-8799
Mailing Address - Fax:
Practice Address - Street 1:247 N POLK ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-4112
Practice Address - Country:US
Practice Address - Phone:541-844-8799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201406752163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse