Basic Information
| Provider Information | |||||||||
| NPI: | 1891870622 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WARING | ||||||||
| FirstName: | JEAN | ||||||||
| MiddleName: | H. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 278 | ||||||||
| Address2: | |||||||||
| City: | WOODBURN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9719835360 | ||||||||
| FaxNumber: | 9719835343 | ||||||||
| Practice Location | |||||||||
| Address1: | 1457 MT. HOOD AVE | ||||||||
| Address2: | |||||||||
| City: | WOODBURN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9719835360 | ||||||||
| FaxNumber: | 9719835343 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2006 | ||||||||
| LastUpdateDate: | 10/28/2015 | ||||||||
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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 | 363LF0000X | 200850037NP FNP-PP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 364SW0102X | 200850037NP FNP-PP | OR | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | 500602581 | 05 | OR | MEDICAID |