Provider Demographics
NPI:1235666272
Name:MY DIRECT HEALTH, LLC
Entity Type:Organization
Organization Name:MY DIRECT HEALTH, LLC
Other - Org Name:LAURIE DAHL, FNP
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:DAHL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:541-500-0561
Mailing Address - Street 1:700 TWIN CREEKS CROSSING LOOP
Mailing Address - Street 2:SUITE A
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-8661
Mailing Address - Country:US
Mailing Address - Phone:541-500-0561
Mailing Address - Fax:541-225-4874
Practice Address - Street 1:700 TWIN CREEKS CROSSING LOOP
Practice Address - Street 2:SUITE A
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-8661
Practice Address - Country:US
Practice Address - Phone:541-500-0561
Practice Address - Fax:541-982-7287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-22
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201500076NP-PP261QP2300X
363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty