Provider Demographics
NPI:1417983974
Name:PARSONS, JILL MALYNN (RN, WHCNP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MALYNN
Last Name:PARSONS
Suffix:
Gender:F
Credentials:RN, WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-1248
Mailing Address - Country:US
Mailing Address - Phone:541-663-3175
Mailing Address - Fax:541-975-5112
Practice Address - Street 1:610 SUNSET DR
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-1248
Practice Address - Country:US
Practice Address - Phone:541-663-3175
Practice Address - Fax:541-975-5112
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR086000115RN RN163W00000X
OR086000115N7 WHCNP-PP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR079178000OtherBLUE CROSS
OR9305053253024OtherEMPLOYER ID
OR275432Medicaid
OR275432Medicaid
OR9305053253024OtherEMPLOYER ID
OR079178000OtherBLUE CROSS