1750388559 NPI number — DR. JACQUELINE S OSLAND MD

Table of content: DR. JACQUELINE S OSLAND MD (NPI 1750388559)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750388559 NPI number — DR. JACQUELINE S OSLAND MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OSLAND
Provider First Name:
JACQUELINE
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750388559
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
818 N EMPORIA ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67214-3729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-263-0296
Provider Business Mailing Address Fax Number:
316-263-9523

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
390 FOUNDERS WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORKS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98331-9062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-374-6998
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  0424299 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100318690A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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