Healthcare Provider Details

I. General information

NPI: 1265307268
Provider Name (Legal Business Name): LUANNA LEE DISHON MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
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:
Mailing address:
  • Phone: 503-507-5356
  • Fax: 866-225-2708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF10250250
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: