Individual
MICHELLE DEZURA ANTHONY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
5125 SKYLINE RD S, SALEM, OR 97306-9427
(503) 315-4663
Mailing address
5125 SKYLINE RD S, SALEM, OR 97306-9413
(503) 315-4663
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
AP04978
LA
363LA2100X
Acute Care Nurse Practitioner
RN79000
LA
363LA2200X
Adult Health Nurse Practitioner
Primary
201392913NP-PP
OR
363LA2200X
Adult Health Nurse Practitioner
AP60436588
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00754042
—
MS
05
—
1013889
—
LA
Enumeration date
02/16/2007
Last updated
03/10/2022
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