Provider Demographics
NPI:1528615564
Name:MCNERLIN, JOAN ANNE
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:ANNE
Last Name:MCNERLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 385
Mailing Address - Street 2:
Mailing Address - City:PORT ORFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97465-0385
Mailing Address - Country:US
Mailing Address - Phone:541-332-0376
Mailing Address - Fax:
Practice Address - Street 1:42078 BLANCHARD RD
Practice Address - Street 2:
Practice Address - City:PORT ORFORD
Practice Address - State:OR
Practice Address - Zip Code:97465
Practice Address - Country:US
Practice Address - Phone:541-332-0376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty