SANTIAM MOBILE MEDICINE LLC (NPI# 1750899035) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750899035 |
| Entity Type | Organization |
| Organization Name | SANTIAM MOBILE MEDICINE LLC |
| Practice Address |
1025 2nd St Nw Salem OR 97304-4001 |
| Mailing Address |
Po Box 63 Sublimity OR 97385-0063 |
| Practice Telephone | 5035075356 |
| Mailing Telephone | 5035075356 |
| Mailing Fax Number | 4695651273 |
| Enumeration Date | 2018-01-20 |
| Last Update Date | 2020-07-01 |
| Authorized Official Name | CASEY LULAY (MEMBER) |
| Authorized Official Telephone | 5035075356 |
| Authorized Official Credential | MSN, FNP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 500673258 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 7657 Sherman Rd Se, Aumsville, OR 973259529 | 5035075356 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | SANTIAM MOBILE MEDICINE LLC | 1025 2nd St Nw, Salem, OR 97304 |
| Street Address |
1025 2ND ST NW |
| City | SALEM |
| State | OR |
| Zip Code | 97304-4001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619421591 | Logan Walters | Physical Therapist | 1025 2nd St Nw, Salem, OR 97304 | 2016-08-09 |
| 1326684135 | Heart and Soul Wellness Clinic LLC | Clinic/Center | 1025 2nd St Nw, Salem, OR 97304-4001 | 2019-11-27 |
| 1386280220 | Compassion Care Family Practice LLC | Family Medicine | 1025 2nd St Nw, Salem, OR 97304-4001 | 2019-11-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114413010 | Sam Mackenzie Lane | Massage Therapist | 1661 Edgewater St Nw # 120, Salem, Or 97304, Salem, OR 97304 | 2018-07-03 |
| 1144761131 | Rachel E Carson | Physical Therapist | 1025 2nd St. Nw, West Salem, OR 97304 | 2017-03-10 |
| 1962951061 | Lee Ann Nail | Social Worker | 3965 Gibson Rd Nw, Salem, OR 97304 | 2016-09-29 |
| 1770941338 | Tysandra Gillis | Massage Therapist | 859 Mule Deer St., Salem, OR 97304 | 2016-02-10 |
| 1144620295 | Molly Rodden | Nurse Practitioner | 1174 Cornucopia St Nw Ste 240, Salem, OR 97304 | 2014-08-26 |
| 1881942126 | Cynthia Ruth Rettler | Registered Nurse | 1520 Plaza St Nw Ste 150, Salem, OR 97304 | 2012-08-16 |
| 1336401017 | Trillium Family Services | Community/Behavioral Health | 1520 Plaza Street Nw, Suite 100, Salem, OR 97304 | 2012-06-08 |
| 1033428198 | Kathleen Ketelson | Nurse Practitioner | 560 Wallace Rd Nw Ste 140, Salem, OR 97304 | 2010-10-06 |
| 1922332535 | Robert Scott Mcadam | Social Worker | 1245 Edgewater St. Nw, Salem, OR 97304 | 2009-09-29 |
| 1992932560 | Michelle Lynn Laseter | Counselor | 290 Moyer Ln. Nw, Salem, OR 97304 | 2009-06-22 |
| Find all providers in zip 97304 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134759012 | Caleb James Calder | Nurse Practitioner | 11 Oakland St, Salem, MA 01970-1520 | 2020-01-20 |
| 1467928184 | Jean David Thomas | Nurse Practitioner | Salem Family Health Center, 47 Congress Street, Salem, MA 01970 | 2018-10-20 |
| 1407371388 | Debra Lee Jenkins | Nurse Practitioner | 1905 Mcvitty Rd, Salem, VA 24153-7405 | 2017-08-11 |
| 1003282310 | Rachell Renee Davis | Nurse Practitioner | 1793 13th St. Se, Salem, OR 97302 | 2015-08-20 |
| 1194108365 | Danielle Marlene Dupuis | Nurse Practitioner | 810 Commercial St Se, Salem, OR 97302 | 2015-07-06 |
| 1306272471 | Josh Hooton | Nurse Practitioner | 251 W State Road 198 Ste 3, Salem, UT 84653-5608 | 2013-09-20 |
| 1104082197 | Richard Fredrick Meyers | Nurse Practitioner | 670 Hawthorne Ave Se, Suite 160, Salem, OR 97301-6884 | 2008-07-30 |
| 1831398122 | Karlen E Luthy | Nurse Practitioner | 118 N Main St Ste B, Salem, UT 84653-5698 | 2007-07-16 |
| 1174603401 | Anthony G Haralabatos | Nurse Practitioner | 59 Stiles Rd 104, Salem, NH 03079-5816 | 2006-10-17 |
| 1457378044 | Robert M Wilkinson | Nurse Practitioner | 141 Hospital Dr Ste 103, Salem, KY 42078-8043 | 2006-07-17 |
| Find all providers in SALEM | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.