1952529810 NPI number — JACKIE J SOCHIN FNP - CERTIFIED

Table of content: JACKIE J SOCHIN FNP - CERTIFIED (NPI 1952529810)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952529810 NPI number — JACKIE J SOCHIN FNP - CERTIFIED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOCHIN
Provider First Name:
JACKIE
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP - CERTIFIED
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:
1952529810
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
544 W. UMPQUA ST
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
ROSEBURG
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97471
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-672-9596
Provider Business Mailing Address Fax Number:
541-464-3519

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
790 S. MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MYRTLE CREEK
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-860-4070
Provider Business Practice Location Address Fax Number:
541-860-5032
Provider Enumeration Date:
04/23/2007

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: 363LF0000X , with the licence number:  NP87-006827-7 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 168395 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: R103163 . This is a "MEDICARE PART B" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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