=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265307268
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUANNA LEE DISHON MSN, APRN, FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2025
-----------------------------------------------------
Last Update Date | 12/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 41805 STAYTON SCIO RD SE
-----------------------------------------------------
City | STAYTON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97383-9739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-507-5356
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 118
-----------------------------------------------------
City | STAYTON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97383-0118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-507-5356
-----------------------------------------------------
Fax | 866-225-2708
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | F10250250
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------