Healthcare Provider Details

I. General information

NPI: 1952529810
Provider Name (Legal Business Name): JACKIE J SOCHIN FNP - CERTIFIED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 01/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 S. MAIN
MYRTLE CREEK OR
97457
US

IV. Provider business mailing address

544 W. UMPQUA ST SUITE 101
ROSEBURG OR
97471
US

V. Phone/Fax

Practice location:
  • Phone: 541-860-4070
  • Fax: 541-860-5032
Mailing address:
  • Phone: 541-672-9596
  • Fax: 541-464-3519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP87-006827-7
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier168395
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer
# 2
IdentifierR103163
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerMEDICARE PART B

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: