Provider Demographics
NPI:1144580259
Name:RIVER ROAD FIRST ASSISTING
Entity type:Organization
Organization Name:RIVER ROAD FIRST ASSISTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LOHMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, RNFA
Authorized Official - Phone:408-506-9988
Mailing Address - Street 1:5434 RIVER RD N
Mailing Address - Street 2:#216
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-4429
Mailing Address - Country:US
Mailing Address - Phone:408-506-9988
Mailing Address - Fax:
Practice Address - Street 1:5434 RIVER RD N
Practice Address - Street 2:#216
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-4429
Practice Address - Country:US
Practice Address - Phone:408-506-9988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200840121RN163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty