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General NPI Number Information
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NPI Number | 1760299986
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Entity Type | Individual
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Provider Name | SALLY ANN LORD NP
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Gender | Female
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Dates
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Enumeration Date | 12/11/2024
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 2340 S 6TH ST
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City | KLAMATH FALLS
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State | OR
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Zip | 97601-4340
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Country | US
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Telephone | 541-204-4933
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Fax | 541-851-2108
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Provider Business Mailing Address
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Address Line | 3265 HILLCREST PARK DR
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City | MEDFORD
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State | OR
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Zip | 97504-7657
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Country | US
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Telephone | 541-494-9355
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Fax |
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 10035005
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License Number State | OR
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