Provider Demographics
NPI:1104082197
Name:MEYERS, RICHARD FREDRICK (RN, FNP-BC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:FREDRICK
Last Name:MEYERS
Suffix:
Gender:M
Credentials:RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 HAWTHORNE AVE SE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-6884
Mailing Address - Country:US
Mailing Address - Phone:503-371-1970
Mailing Address - Fax:503-371-0192
Practice Address - Street 1:670 HAWTHORNE AVE SE
Practice Address - Street 2:SUITE 160
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-6884
Practice Address - Country:US
Practice Address - Phone:503-371-1970
Practice Address - Fax:503-371-0192
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201703016NP-PP363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily