Healthcare Provider Details

I. General information

NPI: 1932551256
Provider Name (Legal Business Name): JONATHAN SCHMIDT RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2016
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 NM GARDEN VALLEY BLVD VA ROSEBURG MEDICAL CENTER
ROSEBURG OR
97471
US

IV. Provider business mailing address

1601 HAMLET LN
EUGENE OR
97402-7540
US

V. Phone/Fax

Practice location:
  • Phone: 541-440-1000
  • Fax:
Mailing address:
  • Phone: 541-600-5089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WU0100X
TaxonomyUrology Registered Nurse
License Number10013211
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number201602799LPN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: