Healthcare Provider Details

I. General information

NPI: 1922841121
Provider Name (Legal Business Name): MARY JO PRICE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2024
Last Update Date: 06/15/2024
Certification Date: 06/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 E BARNETT RD
MEDFORD OR
97504-8332
US

IV. Provider business mailing address

4035 JEROME PRAIRIE RD
GRANTS PASS OR
97527-9517
US

V. Phone/Fax

Practice location:
  • Phone: 541-789-7800
  • Fax:
Mailing address:
  • Phone: 702-493-0331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0002X
TaxonomyHigh-Risk Obstetric Registered Nurse
License Number202008534R
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number202008534R
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: