Provider Demographics
NPI:1578657656
Name:VETTO, IRENE P (ANP)
Entity type:Individual
Prefix:MS
First Name:IRENE
Middle Name:P
Last Name:VETTO
Suffix:
Gender:F
Credentials:ANP
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Other - First Name:
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Mailing Address - Street 1:875 OAK ST SE
Mailing Address - Street 2:SUITE 4030
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3975
Mailing Address - Country:US
Mailing Address - Phone:503-561-6444
Mailing Address - Fax:503-561-6440
Practice Address - Street 1:2700 SE STRATUS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-6255
Practice Address - Country:US
Practice Address - Phone:503-435-6590
Practice Address - Fax:503-435-6591
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR091007206N3363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR239977Medicaid
OR239977Medicaid
ORP07985Medicare UPIN
OR107039Medicare ID - Type UnspecifiedGROUP# MCMINNVILLE