Provider Demographics
NPI:1447034483
Name:GROZOVSKAYA, DAR'YA RAISA (NP)
Entity type:Individual
Prefix:
First Name:DAR'YA
Middle Name:RAISA
Last Name:GROZOVSKAYA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3541 CONCORD ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-1666
Mailing Address - Country:US
Mailing Address - Phone:541-510-1887
Mailing Address - Fax:
Practice Address - Street 1:105 ARNEY RD STE 130
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-9472
Practice Address - Country:US
Practice Address - Phone:503-902-3900
Practice Address - Fax:503-480-1841
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10019888363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily