Basic Information
| Provider Information | |||||||||
| NPI: | 1114092079 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FELTZIN | ||||||||
| FirstName: | JOYA | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CNM FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1020 | ||||||||
| Address2: | |||||||||
| City: | CAVE JUNCTION | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415924619 | ||||||||
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| Practice Location | |||||||||
| Address1: | 625 E RIVER STREET | ||||||||
| Address2: | ILLINOIS VALLEY HIGH SCHOOL STUDENT HEALTH CENTER | ||||||||
| City: | CAVE JUNCTION | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415923749 | ||||||||
| FaxNumber: | 5415923749 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 076036673N1FNPPP | OR | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 367A00000X | 076036673N5NMNP | OR | X | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 022223 | 05 | OR | MEDICAID |