Healthcare Provider Details

I. General information

NPI: 1043642408
Provider Name (Legal Business Name): PEARL ANN JOBE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2013
Last Update Date: 11/27/2023
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 BIRCH AVE
COTTAGE GROVE OR
97424-1416
US

IV. Provider business mailing address

1345 BIRCH AVE
COTTAGE GROVE OR
97424-1416
US

V. Phone/Fax

Practice location:
  • Phone: 541-942-3939
  • Fax: 541-942-9310
Mailing address:
  • Phone: 541-942-3939
  • Fax: 541-942-9310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number201391411
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: