Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | ATI4561 | OR |
NPI | 1013501220 |
---|---|
Provider Name | Dr. Alexandria Nicole Jernberg |
First Address | Eugene, OR 97402-1847 |
Second Address | Eugene, OR 97401-1601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2021 |
Last Update Date | 08/03/2021 |