Provider Demographics
NPI:1821261462
Name:OKSENHOLT, LORRIE M (DO)
Entity type:Individual
Prefix:
First Name:LORRIE
Middle Name:M
Last Name:OKSENHOLT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2589 NW EDENBOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-6224
Mailing Address - Country:US
Mailing Address - Phone:541-672-8533
Mailing Address - Fax:855-670-1788
Practice Address - Street 1:2589 NW EDENBOWER BLVD
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-6224
Practice Address - Country:US
Practice Address - Phone:541-672-8533
Practice Address - Fax:855-670-1788
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV545207R00000X
ORDO219883207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVE82382Medicare UPIN
NVV106503Medicare PIN