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Individual

MR. JACOB K. MCGINNIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
AGACNP-BC

Contact information

Practice address
900 SUNSET DR, LA GRANDE, OR 97850-1387
(541) 963-8421
Mailing address
PO BOX 3290, LA GRANDE, OR 97850-7290
(540) 963-1967

Taxonomy

Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
202011200NP-PP
OR

Other

Enumeration date
10/27/2020
Last updated
03/26/2021
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