Provider Demographics
NPI:1538206115
Name:DRILL, JAN REATHA (RN)
Entity type:Individual
Prefix:MRS
First Name:JAN
Middle Name:REATHA
Last Name:DRILL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4838 49TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-3304
Mailing Address - Country:US
Mailing Address - Phone:503-463-6584
Mailing Address - Fax:503-463-6584
Practice Address - Street 1:4838 49TH AVE NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-3304
Practice Address - Country:US
Practice Address - Phone:503-463-6584
Practice Address - Fax:503-463-6584
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR098345Medicaid