Healthcare Provider Details

I. General information

NPI: 1538146436
Provider Name (Legal Business Name): MERTHEL LURETTA RAND FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 01/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 W ELM AVE
HERMISTON OR
97838-6933
US

IV. Provider business mailing address

1122 W ELM AVE
HERMISTON OR
97838-6933
US

V. Phone/Fax

Practice location:
  • Phone: 541-289-7246
  • Fax: 541-567-5936
Mailing address:
  • Phone: 541-289-7246
  • Fax: 541-567-5936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200250141NP FNP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: