Healthcare Provider Details

I. General information

NPI: 1376481192
Provider Name (Legal Business Name): SKYLAR DOUGLAS LE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2669 NE TWIN KNOLLS DR # 110
BEND OR
97701-4895
US

IV. Provider business mailing address

2669 NE TWIN KNOLLS DR # 110
BEND OR
97701-4895
US

V. Phone/Fax

Practice location:
  • Phone: 541-241-7412
  • Fax:
Mailing address:
  • Phone: 541-241-7412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License NumberBAP-E-10266881
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: