Healthcare Provider Details

I. General information

NPI: 1700779667
Provider Name (Legal Business Name): CAMREN ALLEN MORELAND BSN, RNFA, CNOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 NW HAWTHORNE AVE
GRANTS PASS OR
97526-1041
US

IV. Provider business mailing address

3284 ELK LN
GRANTS PASS OR
97527-9190
US

V. Phone/Fax

Practice location:
  • Phone: 541-472-4880
  • Fax:
Mailing address:
  • Phone: 918-284-3980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number202209929RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: