Provider Demographics
NPI:1073596995
Name:PITTENGER, JANE G (RN, MSN, PMHNP)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:G
Last Name:PITTENGER
Suffix:
Gender:F
Credentials:RN, MSN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 642
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439-0023
Mailing Address - Country:US
Mailing Address - Phone:541-997-6956
Mailing Address - Fax:541-997-9036
Practice Address - Street 1:1495 W 8TH
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439
Practice Address - Country:US
Practice Address - Phone:541-997-6956
Practice Address - Fax:541-997-9036
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR080044416N6363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health