Healthcare Provider Details

I. General information

NPI: 1881518090
Provider Name (Legal Business Name): VICTORIA LEIGH DALZELL BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 E BARNETT RD
MEDFORD OR
97504-8332
US

IV. Provider business mailing address

267 REANNA WAY
MEDFORD OR
97501-1333
US

V. Phone/Fax

Practice location:
  • Phone: 541-789-7000
  • Fax:
Mailing address:
  • Phone: 360-544-2223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: