Healthcare Provider Details

I. General information

NPI: 1750899035
Provider Name (Legal Business Name): SANTIAM MOBILE MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2018
Last Update Date: 05/31/2025
Certification Date: 05/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41805 STAYTON SCIO RD SE
STAYTON OR
97383-9739
US

IV. Provider business mailing address

PO BOX 118
STAYTON OR
97383-0118
US

V. Phone/Fax

Practice location:
  • Phone: 503-507-5356
  • Fax: 866-225-2708
Mailing address:
  • Phone: 503-507-5356
  • Fax: 866-225-1708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CASEY LULAY
Title or Position: MEMBER
Credential: MSN, FNP
Phone: 503-507-5356