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NPI Code Detail

MEDICARE: LORETTA CHURCH PA-C

MEDICARE: LORETTA CHURCH PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA202993OR

General Provider Information

NPI Number : 1982168415
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORETTA CHURCH PA-C
Provider Business Mailing Address
First Line : PO BOX 1517
Second Line :
City : PENDLETON
State : OR
Zip : 97801-0410
Country : US
Telephone Number : 877-708-1119
Fax Number : 541-278-8349
Provider Business Practice Location Address
First Line : 1001 MOLALLA AVE STE 100
Second Line :
City : OREGON CITY
State : OR
Zip : 97045-3753
Country : US
Telephone Number : 503-656-5273
Fax Number : 503-650-4828
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2019
Last Update Date : 11/06/2025

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Directions to “ LORETTA CHURCH PA-C” Practice Location

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