Provider Demographics
NPI:1366858334
Name:DUYVEJONCK, ALICIA L (DNP)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:L
Last Name:DUYVEJONCK
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:L
Other - Last Name:SHREFFLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 HAYDEN BRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-1347
Mailing Address - Country:US
Mailing Address - Phone:541-868-9430
Mailing Address - Fax:541-868-9450
Practice Address - Street 1:1 HAYDEN BRIDGE WAY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-1347
Practice Address - Country:US
Practice Address - Phone:541-868-9430
Practice Address - Fax:541-868-9450
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10031008363L00000X
IAH108094363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner