Provider Demographics
NPI:1578811824
Name:JUNGLING, MISTY
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:JUNGLING
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 1:634 NE CLOVER AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-1406
Mailing Address - Country:US
Mailing Address - Phone:541-643-7046
Mailing Address - Fax:
Practice Address - Street 1:634 NE CLOVER AVE
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-1406
Practice Address - Country:US
Practice Address - Phone:541-643-7046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201042841RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse