MEDICARE: LOAN NGUYEN WADE

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	363L00000X	Nurse Practitioner	2025060302	OR

General Provider Information

NPI Number	:	1184595241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOAN NGUYEN WADE

Provider Business Mailing Address
First Line	:	1880 LANCASTER DR NE STE 104
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97305-1040
Country	:	US
Telephone Number	:	971-273-0679
Fax Number	:	503-961-0794

Provider Business Practice Location Address
First Line	:	1880 LANCASTER DR NE STE 104
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97305-1040
Country	:	US
Telephone Number	:	971-273-0679
Fax Number	:	503-961-0794

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2025
Last Update Date	:	09/13/2025

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Directions to “ LOAN NGUYEN WADE ” Practice Location

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