Healthcare Provider Details

I. General information

NPI: 1558565028
Provider Name (Legal Business Name): JODI B YAVER MSN, PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 01/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 GREEN ACRES RD
EUGENE OR
97408-6501
US

IV. Provider business mailing address

2073 OLYMPIC ST
SPRINGFIELD OR
97477-3413
US

V. Phone/Fax

Practice location:
  • Phone: 541-682-3550
  • Fax: 541-682-9958
Mailing address:
  • Phone: 541-682-3550
  • Fax: 541-682-9958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number200750038NP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number5004166
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number5004166
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number200750037NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: