MEDICARE: LEA DYE-BLONDELL

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	363AM0700X	Medical Physician Assistant
2	363A00000X	Physician Assistant	PA180725	OR

General Provider Information

NPI Number	:	1720521008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEA DYE-BLONDELL

Provider Business Mailing Address
First Line	:	3311 RIVERBEND DR # 300
Second Line	:
City	:	SPRINGFIELD
State	:	OR
Zip	:	97477-8800
Country	:	US
Telephone Number	:	541-484-4332
Fax Number	:	541-242-6770

Provider Business Practice Location Address
First Line	:	3311 RIVERBEND DR # 300
Second Line	:
City	:	SPRINGFIELD
State	:	OR
Zip	:	97477-8800
Country	:	US
Telephone Number	:	541-484-4332
Fax Number	:	541-242-6770

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

Provider Enumeration Date	:	11/18/2016
Last Update Date	:	06/15/2026

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Directions to “ LEA DYE-BLONDELL ” Practice Location

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