Healthcare Provider Details

I. General information

NPI: 1295661122
Provider Name (Legal Business Name): LILA BACKER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELLIE BACKER RN

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 VALINDA WAY
KLAMATH FALLS OR
97603-7586
US

IV. Provider business mailing address

3737 VALINDA WAY
KLAMATH FALLS OR
97603
US

V. Phone/Fax

Practice location:
  • Phone: 541-331-6210
  • Fax:
Mailing address:
  • Phone: 541-331-6210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number201607252RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: