MS. JERI PAIRISH-LACK (NPI# 1497754329) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497754329 |
| Entity Type | Individual |
| Full Name | MS. JERI PAIRISH-LACK |
| Credential | CFNP |
| Practice Address |
124 Nw Midland Ave Ste J Grants Pass OR 97526-1269 |
| Practice Telephone | 5414768859 |
| Practice Fax Number | 5419558611 |
| Mailing Telephone | 5414768859 |
| Mailing Fax Number | 5419558611 |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2007-10-01 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
094006084N1 | OR | Physician Assistants & Advanced Practice Nursing Providers |
| N | 207Q00000X | Family Medicine | OR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 000473 | 05 |
| Street Address |
124 NW MIDLAND AVE STE J |
| City | GRANTS PASS |
| State | OR |
| Zip Code | 97526-1269 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518964766 | Mark Allen Rondeau | Family Medicine | 124 Nw Midland Ave, Grants Pass, OR 97526-1269 | 2005-07-01 |
| 1154621613 | Judith A King Mn Fnp PC | Nurse Practitioner | 124 Nw Midland Ave, Grants Pass, OR 97526-1269 | 2010-10-29 |
| 1861674780 | Mark Allen Rondeau | Family Medicine | 124 Nw Midland Ave, Ste J, Grants Pass, OR 97526-1269 | 2007-12-03 |
| 1821285669 | Daniel L Moline, Md, PC | Family Medicine | 124 Nw Midland Ave, Suite 108, Grants Pass, OR 97526-1269 | 2007-09-25 |
| 1639195340 | J1 Medical Clinic | Clinic/Center | 124 Nw Midland Ave, Suite 110, Grants Pass, OR 97526-1269 | 2006-07-14 |
| 1801821426 | Chutuoc C. Trandinh, M.d., L.L.C. | Specialist | 124 Nw Midland Ave, Suite 109, Grants Pass, OR 97526-1269 | 2006-07-12 |
| 1447242714 | Daniel Moline | Family Medicine | 124 Nw Midland Ave, Grants Pass, OR 97526-1269 | 2005-08-22 |
| 1093715930 | Carol Thomas | Nurse Practitioner | 124 Nw Midland Ave, Ste J, Grants Pass, OR 97526-1269 | 2005-07-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205476777 | Kyla M Mccormick | Peer Specialist | 109 Nw Manzanita Avenue, Grants Pass, OR 97526 | 2020-01-13 |
| 1164076469 | Alicia Yvonne Hansen | Counselor | 1055 Clarey St., Grants Pass, OR 97526 | 2019-07-25 |
| 1841842598 | Michael Liam Reynolds, Dds, LLC | Dentist | 984 Ne 8th Street, Grants Pass Oregon, Grants Pass, OR 97526 | 2019-07-12 |
| 1881254746 | Brandi Mccrorey | Counselor | 418 Ne 6th Street, Suite 102, Grants Pass, OR 97526 | 2019-06-13 |
| 1700364502 | Premier Community Supports, LLC. | Day Training, Developmentally Disabled Services | 1439 Ne 6th St Ste C, Grants Pass, OR 97526 | 2018-08-02 |
| 1821584509 | Stefani Mcintyre | Massage Therapist | 1590 Se N Street, Warehouse #1574, Grants Pass, OR 97526 | 2018-07-06 |
| 1114467438 | Sandra P Martin | Chiropractor | 333 Sw 5th St. Suite B, Grants Pass, OR 97526 | 2017-03-06 |
| 1801347612 | Maci Wageman | Counselor | 1215 Sw G St Grants Pass Oregon 97526, Grants Pass, OR 97526 | 2016-10-17 |
| 1902353907 | Optimal Health of Southern Oregon, LLC | Family Medicine | 1600 Nw 6th St South Suite, Grants Pass, OR 97526 | 2016-09-07 |
| 1982150793 | Tanya White | Counselor | 402 Nw Fstreet, Grants Pass, OR 97526 | 2016-08-31 |
| Find all providers in zip 97526 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285101527 | Angela Lynn Potter | Nurse Practitioner | 1536 Rj Dr, Grants Pass, OR 97526-3680 | 2018-10-24 |
| 1184000549 | Southern Oregon Medical Practice LLC | Nurse Practitioner | 824 Unit B, Rogue River Highway, Grants Pass, OR 97527-0000 | 2015-08-07 |
| 1215290101 | Livia Leora Klein | Nurse Practitioner | 1734 Sw Waterstone Dr, Grants Pass, OR 97527-6437 | 2012-06-17 |
| 1295966083 | Medical House Calls By Dan Hughes-fnp LLC | Nurse Practitioner | 1505 Nw Prospect Ave, Grants Pass, OR 97526-1007 | 2009-07-28 |
| 1053483057 | Raymond A Millette | Nurse Practitioner | 1014 Ne 7th St, Grants Pass, OR 97526-1420 | 2006-11-14 |
| 1699864736 | Karen Joyce Hoskins | Nurse Practitioner | 1100 Ne 7th St Ste C, Grants Pass, OR 97526-1415 | 2006-10-12 |
| 1376630673 | Kathleen Anne Johnson | Nurse Practitioner | 1692 Williams Hwy, Grants Pass, OR 97527-1805 | 2006-10-06 |
| 1356355846 | Mason Clarke Harrison | Nurse Practitioner | 1833 Nebraska Ave, Grants Pass, OR 97527-5701 | 2006-07-28 |
| 1891796496 | Kathryn Ruth Desantis | Nurse Practitioner | 1378 Sw David Dr, Grants Pass, OR 97527-6429 | 2005-08-03 |
| 1316560865 | Rachel Jessica Vanderwall | Nurse Practitioner | 741 Ne 6th St, Grants Pass, OR 97526-1556 | 2020-05-19 |
| Find all providers in GRANTS PASS | ||||
| City | GRANTS PASS |
| Zip Code | 97526 |
Please comment or provide details below to improve the information on MS. JERI PAIRISH-LACK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.