Healthcare Provider Details

I. General information

NPI: 1558654681
Provider Name (Legal Business Name): PATRICIA JAEGER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2011
Last Update Date: 05/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 PLAGEMAN BLDG
CORVALLIS OR
97331-8567
US

IV. Provider business mailing address

PO BOX 12186
SALEM OR
97309-0186
US

V. Phone/Fax

Practice location:
  • Phone: 541-737-7571
  • Fax:
Mailing address:
  • Phone: 503-999-5219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number088006379RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: