Provider Demographics
NPI:1376588111
Name:FENRICH, YVONNE L (WHCNP, MSN)
Entity Type:Individual
Prefix:MS
First Name:YVONNE
Middle Name:L
Last Name:FENRICH
Suffix:
Gender:F
Credentials:WHCNP, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 ELM ST SW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-1956
Mailing Address - Country:US
Mailing Address - Phone:541-812-4850
Mailing Address - Fax:541-812-4889
Practice Address - Street 1:1229, 1890 WAITE ST #1
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459
Practice Address - Country:US
Practice Address - Phone:541-756-6232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR093000329N5/RN367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORS63824Medicare UPIN