Provider Demographics
NPI:1295151686
Name:LULAY, CASEY (FNP-C)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:LULAY
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 118
Mailing Address - Street 2:
Mailing Address - City:STAYTON
Mailing Address - State:OR
Mailing Address - Zip Code:97383-0118
Mailing Address - Country:US
Mailing Address - Phone:503-507-5356
Mailing Address - Fax:
Practice Address - Street 1:41805 STAYTON SCIO RD SE
Practice Address - Street 2:
Practice Address - City:STAYTON
Practice Address - State:OR
Practice Address - Zip Code:97383-9739
Practice Address - Country:US
Practice Address - Phone:503-507-5356
Practice Address - Fax:866-225-2708
Is Sole Proprietor?:No
Enumeration Date:2014-03-10
Last Update Date:2025-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60451155363LF0000X
OR201404020NP-PP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily