Provider Demographics
NPI:1518987262
Name:HAYMOND, DORA (RN)
Entity Type:Individual
Prefix:
First Name:DORA
Middle Name:
Last Name:HAYMOND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8041 N BANK RD
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-9466
Mailing Address - Country:US
Mailing Address - Phone:541-957-0557
Mailing Address - Fax:541-677-7355
Practice Address - Street 1:8041 N BANK RD
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-9466
Practice Address - Country:US
Practice Address - Phone:541-957-0557
Practice Address - Fax:541-677-7355
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR092006997RN163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health