Provider Demographics
NPI:1518674134
Name:VANDERHOOF, JAMIE ANGELA (RN)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:ANGELA
Last Name:VANDERHOOF
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 N 8TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-1771
Mailing Address - Country:US
Mailing Address - Phone:541-707-0425
Mailing Address - Fax:
Practice Address - Street 1:2040 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-2328
Practice Address - Country:US
Practice Address - Phone:541-756-7531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201905438RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse