Organization
SANTIAM MOBILE MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CASEY LULAY MSN, FNP (MEMBER)
(503) 507-5356
Entity
Organization
Contact information
Practice address
41805 STAYTON SCIO RD SE, STAYTON, OR 97383-9739
(503) 507-5356
(866) 225-2708
Mailing address
PO BOX 118, STAYTON, OR 97383-0118
(503) 507-5356
(866) 225-1708
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500673258
—
OR
05
—
500779652
—
OR
Enumeration date
01/20/2018
Last updated
05/31/2025
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