Provider Demographics
NPI:1689992117
Name:SCHMUNK, JILLIAN COLLEEN (MD)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:COLLEEN
Last Name:SCHMUNK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:COLLEEN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5848 MOOSEBERRY CT SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-9845
Mailing Address - Country:US
Mailing Address - Phone:503-314-3116
Mailing Address - Fax:
Practice Address - Street 1:890 OAK STREET, SE, BUILDING A
Practice Address - Street 2:SALEM EMERGENCY PHYSICIANS SERVICES
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301
Practice Address - Country:US
Practice Address - Phone:503-561-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-07
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD161938207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine