1417983974 NPI number — JILL MALYNN PARSONS RN, WHCNP

Table of content: JILL MALYNN PARSONS RN, WHCNP (NPI 1417983974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417983974 NPI number — JILL MALYNN PARSONS RN, WHCNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARSONS
Provider First Name:
JILL
Provider Middle Name:
MALYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, WHCNP
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:
1417983974
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
610 SUNSET DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA GRANDE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97850-1248
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-663-3175
Provider Business Mailing Address Fax Number:
541-975-5112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 SUNSET DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA GRANDE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97850-1248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-663-3175
Provider Business Practice Location Address Fax Number:
541-975-5112
Provider Enumeration Date:
06/24/2006

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: 163W00000X , with the licence number:  086000115RN RN , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LW0102X , with the licence number: 086000115N7 WHCNP-PP , 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: 079178000 . This is a "BLUE CROSS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 9305053253024 . This is a "EMPLOYER ID" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 275432 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com