Provider Demographics
NPI:1689128308
Name:SALEM HEALTH
Entity Type:Organization
Organization Name:SALEM HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCQUILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:503-910-7723
Mailing Address - Street 1:2925 RIVER RD S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-3677
Mailing Address - Country:US
Mailing Address - Phone:503-814-4400
Mailing Address - Fax:
Practice Address - Street 1:2925 RIVER RD S
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-3677
Practice Address - Country:US
Practice Address - Phone:503-814-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201605270NP-PP261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care