Provider Demographics
NPI:1104075563
Name:FEIN, LARRY JR (RN)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:
Last Name:FEIN
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21815 WILLAMETTE DR
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-3232
Mailing Address - Country:US
Mailing Address - Phone:503-702-6665
Mailing Address - Fax:503-655-0112
Practice Address - Street 1:21815 WILLAMETTE DR
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-3232
Practice Address - Country:US
Practice Address - Phone:503-702-6665
Practice Address - Fax:503-655-0112
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200040489RN163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health