Basic Information
| Provider Information | |||||||||
| NPI: | 1144954215 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RIMC LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1245 NW 4TH ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | REDMOND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977561680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413234545 | ||||||||
| FaxNumber: | 5413234546 | ||||||||
| Practice Location | |||||||||
| Address1: | 1245 NW 4TH ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | REDMOND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977561680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413234545 | ||||||||
| FaxNumber: | 5413234546 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2022 | ||||||||
| LastUpdateDate: | 07/13/2022 | ||||||||
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| AuthorizedOfficialLastName: | MCMILLIAN | ||||||||
| AuthorizedOfficialFirstName: | LORI | ||||||||
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| AuthorizedOfficialTitleorPosition: | FNP/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5413234540 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | FNP | ||||||||
| NPICertificationDate: | 07/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.