Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 20200109NP-PP | OR |
NPI | 1023649605 |
---|---|
Provider Name | Jenny V Tausch |
First Address | Winston, OR 97496-4526 |
Second Address | Winston, OR 97496-4526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2020 |
Last Update Date | 20/09/2020 |