Provider Demographics
NPI:1760986251
Name:FIELD, JOAN (CHW)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:FIELD
Suffix:
Gender:F
Credentials:CHW
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 307
Mailing Address - Street 2:
Mailing Address - City:FOSSIL
Mailing Address - State:OR
Mailing Address - Zip Code:97830-0307
Mailing Address - Country:US
Mailing Address - Phone:541-763-2725
Mailing Address - Fax:
Practice Address - Street 1:712 JAY ST
Practice Address - Street 2:
Practice Address - City:FOSSIL
Practice Address - State:OR
Practice Address - Zip Code:97830-8371
Practice Address - Country:US
Practice Address - Phone:541-763-2725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW1954172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker