MEDICARE: RIVER ROAD FIRST ASSISTING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WR0006X	Registered Nurse First Assistant	200840121RN	OR

General Provider Information

NPI Number	:	1144580259
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVER ROAD FIRST ASSISTING

Provider Business Mailing Address
First Line	:	5434 RIVER RD N
Second Line	:	#216
City	:	KEIZER
State	:	OR
Zip	:	97303-4429
Country	:	US
Telephone Number	:	408-506-9988
Fax Number	:

Provider Business Practice Location Address
First Line	:	5434 RIVER RD N
Second Line	:	#216
City	:	KEIZER
State	:	OR
Zip	:	97303-4429
Country	:	US
Telephone Number	:	408-506-9988
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	MS. DEBRA ANN LOHMEYER
Credential	:	RN, RNFA
Telephone Number	:	408-506-9988

Provider Enumeration Date	:	05/22/2012
Last Update Date	:	05/22/2012

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Directions to “RIVER ROAD FIRST ASSISTING ” Practice Location

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