Healthcare Provider Details

I. General information

NPI: 1881914778
Provider Name (Legal Business Name): AMY JARVIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY BALTZOR RN

II. Dates (important events)

Enumeration Date: 06/02/2010
Last Update Date: 06/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 NE A ST
MADRAS OR
97741-1844
US

IV. Provider business mailing address

1505 NW BIRCH LN
MADRAS OR
97741-9044
US

V. Phone/Fax

Practice location:
  • Phone: 541-460-4030
  • Fax: 541-475-0602
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number086003275RN
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number086003275RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: