Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 201050079NP | OR |
NPI | 1003136334 |
---|---|
Provider Name | Jonathan Andrew Mcfadyen |
First Address | Bend, OR 97701-6051 |
Second Address | Bend, OR 97701-6051 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2010 |
Last Update Date | 07/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00936658 | MEDICARE RAILROAD (01) | OR |
500623623 | (05) | OR |