Provider Demographics
NPI:1346680097
Name:ENVISION WOMEN'S HEALTH AND WELLNESS, LLC
Entity Type:Organization
Organization Name:ENVISION WOMEN'S HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:STAUFF
Authorized Official - Last Name:LIEBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CNM, MSN, NP
Authorized Official - Phone:541-753-6000
Mailing Address - Street 1:3080 NW AUTUMN ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3802
Mailing Address - Country:US
Mailing Address - Phone:541-753-6000
Mailing Address - Fax:541-753-6001
Practice Address - Street 1:833 NW BUCHANAN AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6217
Practice Address - Country:US
Practice Address - Phone:541-753-6000
Practice Address - Fax:541-753-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR088000249N5-PP261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center