Provider Demographics
NPI:1689116071
Name:LABILLES, JOBAIL NAVIDA (LPN)
Entity Type:Individual
Prefix:MR
First Name:JOBAIL
Middle Name:NAVIDA
Last Name:LABILLES
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3513 SILVERPARK PL NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-2012
Mailing Address - Country:US
Mailing Address - Phone:541-974-1010
Mailing Address - Fax:
Practice Address - Street 1:3871 FAIRVIEW INDUSTRIAL DR SE
Practice Address - Street 2:SUITE # 150
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1180
Practice Address - Country:US
Practice Address - Phone:503-391-9762
Practice Address - Fax:503-315-2019
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201601769LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse