Healthcare Provider Details

I. General information

NPI: 1508092214
Provider Name (Legal Business Name): LORIE SUSANNE SAITO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 06/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 ARLINGTON MALL
ARLINGTON OR
97812
US

IV. Provider business mailing address

P.O. BOX 314
ARLINGTON OR
97812
US

V. Phone/Fax

Practice location:
  • Phone: 541-454-2888
  • Fax:
Mailing address:
  • Phone: 541-454-2888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200950033NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: