Individual
JACOB ROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP- C
Contact information
Practice address
1600 DELTA WATERS RD STE 107, MEDFORD, OR 97504-9114
(541) 858-2515
Mailing address
815 N CENTRAL AVE STE C, MEDFORD, OR 97501-5873
(541) 734-9030
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
1
UT
363LF0000X
Family Nurse Practitioner
Primary
10031846
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10031846
OREGON NURSING LICENSE
OR
05
—
500841831
—
OR
Enumeration date
10/23/2023
Last updated
10/23/2024
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