Healthcare Provider Details

I. General information

NPI: 1144580259
Provider Name (Legal Business Name): RIVER ROAD FIRST ASSISTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5434 RIVER RD N #216
KEIZER OR
97303-4429
US

IV. Provider business mailing address

5434 RIVER RD N #216
KEIZER OR
97303-4429
US

V. Phone/Fax

Practice location:
  • Phone: 408-506-9988
  • Fax:
Mailing address:
  • Phone: 408-506-9988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number200840121RN
License Number StateOR

VIII. Authorized Official

Name: MS. DEBRA ANN LOHMEYER
Title or Position: OFFICER
Credential: RN, RNFA
Phone: 408-506-9988