Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 4704303766 | MI |
Y | 363LA2100X | Nurse Practitioner - Acute Care | 202105083NP-PP | OR |
NPI | 1033774955 |
---|---|
Provider Name | Mr. Matthew C Jobson |
First Address | Coos Bay, OR 97420-2198 |
Second Address | Coos Bay, OR 97420-2198 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2019 |
Last Update Date | 30/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2020127644 | AMERICAN NURSES CREDENTIALING CENTER NP CERTIFICATION (01) | |
202105083NP-PP | NURSE PRACTITIONER LICENSE (01) | OR |
4704303766 | REGISTERED NURSE LICENSE NUMBER (01) | MI |