Provider Demographics
NPI:1821639394
Name:KIRTNER, RAYA
Entity Type:Individual
Prefix:
First Name:RAYA
Middle Name:
Last Name:KIRTNER
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 1:1305 HILL ST SE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322-6711
Mailing Address - Country:US
Mailing Address - Phone:541-967-6580
Mailing Address - Fax:
Practice Address - Street 1:1305 HILL ST SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-6711
Practice Address - Country:US
Practice Address - Phone:541-967-6580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker