Basic Information
| Provider Information | |||||||||
| NPI: | 1689992117 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHMUNK | ||||||||
| FirstName: | JILLIAN | ||||||||
| MiddleName: | COLLEEN | ||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | BROWN | ||||||||
| OtherFirstName: | JILLIAN | ||||||||
| OtherMiddleName: | COLLEEN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5848 MOOSEBERRY CT SE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973069845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033143116 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 890 OAK STREET, SE, BUILDING A | ||||||||
| Address2: | SALEM EMERGENCY PHYSICIANS SERVICES | ||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035615200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2010 | ||||||||
| LastUpdateDate: | 01/30/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD161938 | OR | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.