Healthcare Provider Details

I. General information

NPI: 1467497370
Provider Name (Legal Business Name): JASON MATTHEW BISCHOFF FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 WALLACE RD NW STE 140
SALEM OR
97304-3858
US

IV. Provider business mailing address

2111 MOUSEBIRD AVE NW
SALEM OR
97304-2022
US

V. Phone/Fax

Practice location:
  • Phone: 971-273-2023
  • Fax: 844-742-2446
Mailing address:
  • Phone: 503-361-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP1656
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN120573
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201608786NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: