Provider Demographics
NPI:1669951745
Name:MCCOLLAM, RANA
Entity type:Individual
Prefix:MISS
First Name:RANA
Middle Name:
Last Name:MCCOLLAM
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:RAYANN
Other - Middle Name:
Other - Last Name:MCCOLLAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1243 PEACE ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-2549
Mailing Address - Country:US
Mailing Address - Phone:503-576-0965
Mailing Address - Fax:
Practice Address - Street 1:1599 STATE ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4255
Practice Address - Country:US
Practice Address - Phone:503-363-3260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORKWA4451COtherOHP