Provider Demographics
NPI:1306412812
Name:EWBANK, IRYNA V
Entity Type:Individual
Prefix:
First Name:IRYNA
Middle Name:V
Last Name:EWBANK
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 1:500 SUMMER ST NE # E-86
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-1064
Mailing Address - Country:US
Mailing Address - Phone:503-945-9708
Mailing Address - Fax:
Practice Address - Street 1:3086 MEMORY LN
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-1838
Practice Address - Country:US
Practice Address - Phone:541-505-1930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker