Provider Demographics
NPI:1043053671
Name:HOUSE, REAGAN ELAINE (LPN)
Entity type:Individual
Prefix:
First Name:REAGAN
Middle Name:ELAINE
Last Name:HOUSE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:REAGAN
Other - Middle Name:ELAINE
Other - Last Name:KELSAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:432 W 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3451
Mailing Address - Country:US
Mailing Address - Phone:541-682-4464
Mailing Address - Fax:541-682-3967
Practice Address - Street 1:432 W 11TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3451
Practice Address - Country:US
Practice Address - Phone:541-682-4464
Practice Address - Fax:541-682-3967
Is Sole Proprietor?:No
Enumeration Date:2024-06-12
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201909214LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse