Provider Demographics
NPI:1174211965
Name:HAFNER, TRICIA DAWN
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:DAWN
Last Name:HAFNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:DAWN
Other - Last Name:NOEGELI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1388 WILSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:STAYTON
Mailing Address - State:OR
Mailing Address - Zip Code:97383-9591
Mailing Address - Country:US
Mailing Address - Phone:035-779-5147
Mailing Address - Fax:503-868-7286
Practice Address - Street 1:890 OAK ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3905
Practice Address - Country:US
Practice Address - Phone:503-779-5147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-28
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
ORTHW000105249374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORTHW000105249OtherTHW