Healthcare Provider Details

I. General information

NPI: 1043078736
Provider Name (Legal Business Name): MARIE JASMINE HUTCHINSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIE JASMINE JONES

II. Dates (important events)

Enumeration Date: 03/08/2024
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4078 SCOTTDALE ST
EUGENE OR
97404-1224
US

IV. Provider business mailing address

5305 RIVER RD N STE B
KEIZER OR
97303-5324
US

V. Phone/Fax

Practice location:
  • Phone: 909-248-4207
  • Fax:
Mailing address:
  • Phone: 909-248-4207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number202101215
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number94067844
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number202101215
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: