Provider Demographics
NPI:1780962209
Name:RYSTROM, MARGARET J (RN, CNL)
Entity type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:J
Last Name:RYSTROM
Suffix:
Gender:F
Credentials:RN, CNL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66258 LEWISTON HWY
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:OR
Mailing Address - Zip Code:97828-5026
Mailing Address - Country:US
Mailing Address - Phone:541-398-2622
Mailing Address - Fax:
Practice Address - Street 1:66258 LEWISTON HWY
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:OR
Practice Address - Zip Code:97828-5026
Practice Address - Country:US
Practice Address - Phone:541-398-2622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200840082RN163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health