Provider Demographics
NPI:1952529810
Name:SOCHIN, JACKIE J (FNP - CERTIFIED)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:J
Last Name:SOCHIN
Suffix:
Gender:F
Credentials:FNP - CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 W. UMPQUA ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471
Mailing Address - Country:US
Mailing Address - Phone:541-672-9596
Mailing Address - Fax:541-464-3519
Practice Address - Street 1:790 S. MAIN
Practice Address - Street 2:
Practice Address - City:MYRTLE CREEK
Practice Address - State:OR
Practice Address - Zip Code:97457
Practice Address - Country:US
Practice Address - Phone:541-860-4070
Practice Address - Fax:541-860-5032
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORNP87-006827-7363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR168395Medicaid
ORR103163OtherMEDICARE PART B
381846Medicare Oscar/Certification
R93664Medicare UPIN
OR38-1846Medicare PIN