Provider Demographics
NPI:1699890764
Name:DEJESUS, NANCY MAY
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:MAY
Last Name:DEJESUS
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 1:3255 GATEWAY ST
Mailing Address - Street 2:139
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2421
Mailing Address - Country:US
Mailing Address - Phone:503-887-5213
Mailing Address - Fax:
Practice Address - Street 1:2145 CENTENNIAL PLZ
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2421
Practice Address - Country:US
Practice Address - Phone:541-684-5825
Practice Address - Fax:541-684-6826
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR99-11-09101YA0400X
372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered372600000XNursing Service Related ProvidersAdult Companion