Healthcare Provider Details

I. General information

NPI: 1417693698
Provider Name (Legal Business Name): JACQUELINE CAHILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 05/10/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8495 CRATER LAKE HWY
WHITE CITY OR
97503-3011
US

IV. Provider business mailing address

2225 N ELDORADO AVE
KLAMATH FALLS OR
97601-6417
US

V. Phone/Fax

Practice location:
  • Phone: 541-273-6206
  • Fax: 541-273-6207
Mailing address:
  • Phone: 541-273-6206
  • Fax: 541-273-6207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number201143150RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: