Doctor Name: | JANICE CODY |
NPI Number: | 1194180562 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 201507748NP-PP |
Business Practice Address: | 750 Nw 4th St Prineville, OR - 977541436 |
Business Phone Number: | 5413628688 |
Business Fax Number: | |
Mailing Address: | 750 Nw 4th St, PRINEVILLE |
State: | OR |
Postal Code: | 977541436 |
Phone Number: | 5413628688 |
Fax Number: | |
NPI Enumeration Date: | 12/29/2015 |
NPI Last Update Date: | 12/29/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 201507748NP-PP |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |