Individual
LANA DE LOS REYES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2532 SOUTHPORT WAY, MEDFORD, OR 97504-5055
(626) 825-2410
Mailing address
2532 SOUTHPORT WAY, MEDFORD, OR 97504-5055
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
201401807LPN
OR
Other
Enumeration date
07/13/2024
Last updated
07/13/2024
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