Provider Demographics
NPI:1700078938
Name:BAIN, JILLIAN FAITH (RN, BS, MS, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:FAITH
Last Name:BAIN
Suffix:
Gender:F
Credentials:RN, BS, MS, FNP-BC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:200 NE MOTHER JOSEPH PL STE 210
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-3295
Mailing Address - Country:US
Mailing Address - Phone:360-254-6161
Mailing Address - Fax:360-449-1146
Practice Address - Street 1:200 NE MOTHER JOSEPH PL STE 305
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-3296
Practice Address - Country:US
Practice Address - Phone:360-254-6161
Practice Address - Fax:360-449-1146
Is Sole Proprietor?:No
Enumeration Date:2007-08-12
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WARN00153028163W00000X
WAAP60024751363LF0000X, 363LF0000X
OR200850076NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1092531Medicaid
OR500683040Medicaid
OR191639Medicare PIN