Provider Demographics
NPI:1508946724
Name:YOMAN, JILL RUDNICK (PA)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:RUDNICK
Last Name:YOMAN
Suffix:
Gender:F
Credentials:PA
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 6149
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97007-0149
Mailing Address - Country:US
Mailing Address - Phone:503-352-8657
Mailing Address - Fax:503-434-8597
Practice Address - Street 1:1151 N. ADAIR ST.
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:OR
Practice Address - Zip Code:97113
Practice Address - Country:US
Practice Address - Phone:503-352-8524
Practice Address - Fax:503-357-4371
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA01353363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500610446Medicaid