Provider Demographics
NPI:1306607064
Name:DRAKES, MARIE LOUISE (RN)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:LOUISE
Last Name:DRAKES
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:TRILLIUM FAMILY SERVICES
Mailing Address - Street 2:4455 NE HIGHWAY 20
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330
Mailing Address - Country:US
Mailing Address - Phone:541-758-7722
Mailing Address - Fax:541-758-5916
Practice Address - Street 1:TRILLIUM FAMILY SERVICES
Practice Address - Street 2:4455 NE HIGHWAY 20
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330
Practice Address - Country:US
Practice Address - Phone:541-758-7722
Practice Address - Fax:541-758-5916
Is Sole Proprietor?:No
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR090007705163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent