Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 000039307N3 | OR |
NPI | 1013927763 |
---|---|
Provider Name | Jean Eileen Mount |
First Address | Grants Pass, OR 97527-9556 |
Second Address | White City, OR 97503-3011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 08/07/2007 |