Provider Demographics
NPI:1871259796
Name:WYGANT, TRISHA C (RN)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:C
Last Name:WYGANT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 LUELLA ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6920
Mailing Address - Country:US
Mailing Address - Phone:541-520-6510
Mailing Address - Fax:
Practice Address - Street 1:151 W 7TH AVE STE 310
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2676
Practice Address - Country:US
Practice Address - Phone:541-682-4041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR084052661RN163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1780822692Medicaid