Provider Demographics
NPI:1639709843
Name:MEYER, JOSHUA DANIEL (RN)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:DANIEL
Last Name:MEYER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MACE RD APT 101
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-1398
Mailing Address - Country:US
Mailing Address - Phone:541-227-1665
Mailing Address - Fax:541-200-6768
Practice Address - Street 1:5 MACE RD APT 101
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-1398
Practice Address - Country:US
Practice Address - Phone:541-227-1665
Practice Address - Fax:541-200-6768
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201391017RN163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health