Healthcare Provider Details

I. General information

NPI: 1922914068
Provider Name (Legal Business Name): MELINDA DEPIERO-GRANT RT(R)(MR)(M)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 GLEN OAK DR
LEBANON OR
97355-3800
US

IV. Provider business mailing address

760 GLEN OAK DR
LEBANON OR
97355-3800
US

V. Phone/Fax

Practice location:
  • Phone: 541-409-5310
  • Fax:
Mailing address:
  • Phone: 541-409-5310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number909622
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code2471M2300X
TaxonomyMammography Radiologic Technologist
License Number909622
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number909622
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: