Provider Demographics
NPI:1174005680
Name:BIRCHWOOD, NINA E
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:E
Last Name:BIRCHWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 E 13TH AVE STE 2B
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3572
Mailing Address - Country:US
Mailing Address - Phone:541-505-9348
Mailing Address - Fax:
Practice Address - Street 1:134 E 13TH AVE
Practice Address - Street 2:STE 2B
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-505-9398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician