Provider Demographics
NPI:1285964304
Name:VIRTUAL NURSE PRACTITIONER LLC
Entity type:Organization
Organization Name:VIRTUAL NURSE PRACTITIONER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:541-419-6337
Mailing Address - Street 1:2654 NE JILL CT
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-5887
Mailing Address - Country:US
Mailing Address - Phone:541-419-6337
Mailing Address - Fax:866-638-8660
Practice Address - Street 1:2654 NE JILL CT
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-5887
Practice Address - Country:US
Practice Address - Phone:541-419-6337
Practice Address - Fax:866-638-8660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR135382OtherOREGON MEDICARE
OR028408Medicaid