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NPI Code Detail

MEDICARE: JORDAN GILLAND

MEDICARE: JORDAN GILLAND
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse257310TN
2363L00000XNurse Practitioner10022974OR
3363LF0000XFamily Nurse Practitioner33026TN

General Provider Information

NPI Number : 1831840693
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN GILLAND
Provider Business Mailing Address
First Line : PO BOX 1189
Second Line :
City : CORVALLIS
State : OR
Zip : 97339-1189
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 531 N HIGHWAY 101 STE A
Second Line :
City : DEPOE BAY
State : OR
Zip : 97341-9572
Country : US
Telephone Number : 541-765-3265
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2022
Last Update Date : 10/28/2024

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Directions to “ JORDAN GILLAND ” Practice Location

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