Healthcare Provider Details

I. General information

NPI: 1629004858
Provider Name (Legal Business Name): LORI MCMILLIAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1523 N CANAL BLVD STE 300
REDMOND OR
97756
US

IV. Provider business mailing address

1523 N CANAL BLVD STE 300
REDMOND OR
97756
US

V. Phone/Fax

Practice location:
  • Phone: 541-548-6505
  • Fax: 541-526-6665
Mailing address:
  • Phone: 541-548-6505
  • Fax: 541-526-6665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateOR

VIII. Authorized Official

Name: LORELEI MCMILLIAN
Title or Position: PRESIDENT
Credential: FNP
Phone: 541-548-6505