Provider Demographics
NPI:1053387860
Name:MCMILLIAN, LORELEI (FNP)
Entity type:Individual
Prefix:
First Name:LORELEI
Middle Name:
Last Name:MCMILLIAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 NW 4TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-1680
Mailing Address - Country:US
Mailing Address - Phone:541-323-4545
Mailing Address - Fax:541-323-4546
Practice Address - Street 1:1245 NW 4TH ST STE 201
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1680
Practice Address - Country:US
Practice Address - Phone:541-323-4545
Practice Address - Fax:541-323-4546
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR091006933RN363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily