Individual provider Active NPI

Manon Gabrielle Vrain, NP

  • Registered Nurse
  • Eugene, OR
National Provider Identifier
1710123427
Registry record updated Feb 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
724402 Issued in CA
Practice address
3355 Chad Dr
Eugene, OR 97408-7428
Phone
(541) 607-7459
Fax
(541) 607-7573
NPI assigned
Dec 30, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Registered Nurse 163WC1500X 74533 CA
Adult Health Nurse Practitioner 363LA2200X 95021318 CA
Registered Nurse 163W00000X 724402 CA Primary

Addresses

Primary practice location

3355 Chad Dr
Eugene, OR 97408-7428

Mailing address

3355 Chad Dr
Eugene, OR 97408-7428
Phone (541) 607-7459

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240326002647 CA Practitioner - Nurse Practitioner 6002253077 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
724402CAMDRegistered Nurse
74533CAMDCommunity Health Registered Nurse
95021318CAMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Minghsun Liu, M.D., PC CurrentSince Mar 18, 2024 Accepting new patients

Locations

11103 Venice Blvd
Los Angeles, CA 90034
Phone (310) 734-8526

200 S Park Rd
Ste 200
Hollywood, FL 33021
Phone (866) 986-2263

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1230595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738713600000",
    "number": "1710123427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3355 CHAD DR",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974087428",
            "telephone_number": "541-607-7459",
            "fax_number": "760-967-4450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3355 CHAD DR",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974087428",
            "telephone_number": "541-607-7459",
            "fax_number": "541-607-7573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VRAIN",
        "first_name": "MANON",
        "middle_name": "GABRIELLE",
        "name_prefix": "Miss",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-12-30",
        "last_updated": "2025-02-05",
        "certification_date": "2025-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC1500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Community Health",
            "state": "CA",
            "license": "74533",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CA",
            "license": "95021318",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "724402",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eugene, OR

Sources for this page

Verify at the official NPI Registry.