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General NPI Number Information
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NPI Number | 1265529721
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Entity Type | Individual
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Provider Name | MARY LOU FOLLETT NP
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Gender | Female
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 03/28/2016
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Provider Practice Location Address
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Address Line | 3156 STATE ST
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City | MEDFORD
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State | OR
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Zip | 97504-8450
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Country | US
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Telephone | 541-773-9772
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Fax | 541-773-1113
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Provider Business Mailing Address
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Address Line | 2921 DOCTORS PARK DR
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City | MEDFORD
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State | OR
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Zip | 97504-8127
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Country | US
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Telephone | 541-245-4444
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Fax | 541-973-2835
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 200250018NP
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License Number State | OR
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