Anthony, Michelle Dezura

Anthony, Michelle Dezura is an sole proprietor health care provider with primary practice located at 5125 Skyline Rd S , Salem OR 97306-9427. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Acute Care, Physician Assistants & Advanced Practice Nursing Providers / Adult Health. Physician Assistants & Advanced Practice Nursing Providers / Adult Health is her primary health care specialty. Anthony, Michelle Dezura can be contacted via phone (503) 315-4663.

Contact Information

Primary practice address
5125 Skyline Rd S Salem OR 97306-9427
Phone: (503) 315-4663
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Acute Care 363LA2100X RN79000 Louisiana
Physician Assistants & Advanced Practice Nursing Providers / Acute Care 363LA2100X AP04978 Louisiana
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X AP60436588 Washington
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X 201392913NP-PP Oregon

Profile Details

NPI number 1649314220
LBN Legal business name Anthony, Michelle Dezura
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 16th, 2007
Last updated Mar 10th, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649314220 NPPES
Mississippi MEDICAID 00754042
Mississippi MEDICAID 1013889

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