Individual
TONI ANNE BACA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
70 BOWER DR, MEDFORD, OR 97501-3689
(541) 734-3430
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(541) 734-3430
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
201806197NP-PP
OR
363LF0000X
Family Nurse Practitioner
209.017695
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500759907
—
OR
Enumeration date
07/30/2018
Last updated
08/29/2022
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