Healthcare Provider Details

I. General information

NPI: 1336069475
Provider Name (Legal Business Name): LANA NAZARIO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 463
SPRINGFIELD OR
97477-0064
US

IV. Provider business mailing address

PO BOX 463
SPRINGFIELD OR
97477-0064
US

V. Phone/Fax

Practice location:
  • Phone: 541-357-6925
  • Fax:
Mailing address:
  • Phone: 541-357-6925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN10009892
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: