Provider Demographics
NPI:1275169484
Name:JAQUETTE, REBECCA JOANNE WEST
Entity Type:Individual
Prefix:
First Name:REBECCA JOANNE
Middle Name:WEST
Last Name:JAQUETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 LOUIS ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-2122
Mailing Address - Country:US
Mailing Address - Phone:541-914-2242
Mailing Address - Fax:
Practice Address - Street 1:705 LOUIS ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-2122
Practice Address - Country:US
Practice Address - Phone:541-914-2242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201390659RN163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant