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General NPI Number Information
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NPI Number | 1164436085
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Entity Type | Organization
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Legal Business Name | REDMOND INTERNAL MEDICINE CLINIC,LLP
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 05/26/2022
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Provider Practice Location Address
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Address Line | 1245 NW 4TH STREET STE 201
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City | REDMOND
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State | OR
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Zip | 97756-1680
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Country | US
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Telephone | 541-323-4545
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Fax | 541-323-4546
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Provider Business Mailing Address
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Address Line | 1245 NW 4TH STREET STE 201
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City | REDMOND
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State | OR
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Zip | 97756-1680
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Country | US
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Telephone | 541-323-4545
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Fax | 541-323-4546
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Authorized Official
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Title or Position | OWNER
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Name | LORELEI MCMILLIAN
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Credential | FNP
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Telephone | 541-323-4540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD19294/MD23086
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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