Basic Information
| Provider Information | |||||||||
| NPI: | 1528386604 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARTSOCK-VANDINE | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2640 E BARNETT RD # E333 | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975044301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412826770 | ||||||||
| FaxNumber: | 5412826771 | ||||||||
| Practice Location | |||||||||
| Address1: | 2825 E BARNETT RD | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975048332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412826770 | ||||||||
| FaxNumber: | 5412826771 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2010 | ||||||||
| LastUpdateDate: | 07/16/2019 | ||||||||
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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 | 207Q00000X | 35.098488 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | MD194260 | OR | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.