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NPI Code Detail

MEDICARE: JANE ELLEN BIRDSONG FNP-C

MEDICARE:   JANE ELLEN BIRDSONG  FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician201708230NP-PPOR

General Provider Information

NPI Number : 1366954794
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANE ELLEN BIRDSONG FNP-C
Provider Business Mailing Address
First Line : 890 OAK ST SE BLDG B
Second Line :
City : SALEM
State : OR
Zip : 97301-3905
Country : US
Telephone Number : 503-814-3217
Fax Number : 503-814-3898
Provider Business Practice Location Address
First Line : 966 12TH ST SE STE 130
Second Line :
City : SALEM
State : OR
Zip : 97302-2860
Country : US
Telephone Number : 503-814-4400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2017
Last Update Date : 10/25/2017

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Directions to “ JANE ELLEN BIRDSONG FNP-C” Practice Location

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