Provider Demographics
NPI:1750923801
Name:TOVAR, MICHELLE LYN (QHMA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYN
Last Name:TOVAR
Suffix:
Gender:F
Credentials:QHMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 SILVERTON RD NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-0100
Mailing Address - Country:US
Mailing Address - Phone:503-362-5918
Mailing Address - Fax:503-361-2650
Practice Address - Street 1:2045 SILVERTON RD NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-0100
Practice Address - Country:US
Practice Address - Phone:503-362-5918
Practice Address - Fax:503-361-2650
Is Sole Proprietor?:No
Enumeration Date:2019-10-10
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR101YM0800XMedicaid