Provider Demographics
NPI:1447045299
Name:VARHAUL, DUSTIN M (CRM)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:M
Last Name:VARHAUL
Suffix:
Gender:
Credentials:CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 N 3RD ST STE 105
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97446-9679
Mailing Address - Country:US
Mailing Address - Phone:541-357-4603
Mailing Address - Fax:541-995-5013
Practice Address - Street 1:5105 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97478-6214
Practice Address - Country:US
Practice Address - Phone:541-357-4603
Practice Address - Fax:541-995-5013
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24-CRM-3723175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty