Healthcare Provider Details

I. General information

NPI: 1073672002
Provider Name (Legal Business Name): JEAN ANN FARMER R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73265 CONFEDERATED WAY
PENDLETON OR
97801
US

IV. Provider business mailing address

3211 SW JAY AVE
PENDLETON OR
97801-3634
US

V. Phone/Fax

Practice location:
  • Phone: 541-966-9830
  • Fax: 541-278-7572
Mailing address:
  • Phone: 541-966-8980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number354486
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: