Provider Demographics
NPI:1285672873
Name:DRYLAND, CAROLINE H (FNP)
Entity type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:H
Last Name:DRYLAND
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:CAROLINE
Other - Middle Name:H
Other - Last Name:VIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:19 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7337
Mailing Address - Country:US
Mailing Address - Phone:541-773-3863
Mailing Address - Fax:541-618-4413
Practice Address - Street 1:19 MYRTLE ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7337
Practice Address - Country:US
Practice Address - Phone:541-773-3863
Practice Address - Fax:541-618-4413
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227698Medicaid
OR227698Medicaid
OR133887Medicare ID - Type Unspecified