LEIANA LUTZ JAGOLINO (NPI# 1538459599) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1538459599 |
Entity Type | Individual |
Full Name | LEIANA LUTZ JAGOLINO |
Credential | PA |
Practice Address |
2925 Ryan Dr Se Salem OR 97301-9687 |
Practice Telephone | 5033991262 |
Practice Fax Number | 5033710777 |
Mailing Telephone | (503) 399-1262 |
Mailing Fax Number | 5033710777 |
Enumeration Date | 2011-04-12 |
Last Update Date | 2018-03-17 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 363A00000X | Physician Assistant | 006077 | GA | Physician Assistants & Advanced Practice Nursing Providers |
Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA167677 | OR | Physician Assistants & Advanced Practice Nursing Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
GA | 003109002A | 05 | |
WA | 2044027 | 05 | |
OR | 500685132 | 05 |
Address | Telephone Number | Fax Number |
---|---|---|
19250 Sw 90th Ave, Tualatin, OR 970627585 | 5036923750 | 5036912324 |
Street Address |
2925 RYAN DR SE |
City | SALEM |
State | OR |
Zip Code | 97301-9687 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1417908757 | Jose Novoa | Radiology | 2925 Ryan Dr Se, Salem, OR 97301-9687 | 2006-05-12 |
1083255541 | Kristi Souza | Physician Assistant | 2925 Ryan Dr Se, Salem, OR 97301-9687 | 2019-10-04 |
1306494638 | Hazel Milano | Physician Assistant | 2925 Ryan Dr Se, Salem, OR 97301-9687 | 2019-08-29 |
1255804233 | Shannon Jean Palmer | Physician Assistant | 2925 Ryan Dr Se, Salem, OR 97301-9687 | 2019-01-02 |
1326454885 | Jessica M Hoyle | Radiology | 2925 Ryan Dr Se, Salem, OR 97301-9687 | 2014-07-05 |
1104236371 | Lauren A Hodgson | Physician Assistant | 2925 Ryan Dr Se, Salem, OR 97301-9687 | 2014-04-28 |
1053721258 | Jason Cody Hedge | Radiology | 2925 Ryan Dr Se, Salem, OR 97301-9687 | 2014-04-28 |
1174940126 | David Prosser | Radiology | 2925 Ryan Dr Se, Salem, OR 97301-9687 | 2014-03-27 |
1659639557 | Ryan Moore | Radiology | 2925 Ryan Dr Se, Salem, OR 97301 | 2012-04-27 |
1710252036 | Tyler Robert Moore | Radiology | 2925 Ryan Dr Se, Salem, OR 97301 | 2012-03-20 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1205450970 | Jehan Seals | Behavior Technician | 3400 State St Set G750, Salem, OR 97301 | 2020-05-29 |
1093335929 | Sterling Recovery, LLC | Dietitian, Registered | 3758 Amber St Ne #105, Salem, OR 97301 | 2020-04-21 |
1760018360 | Riverfront Mental Health LLC | Counselor | 338 State St, Suite 985, Salem, OR 97301 | 2020-03-16 |
1871126888 | Amity Beth Haddon Maxwell | Social Worker | Oregon State Hospital, 2600 Center St Ne, Salem, OR 97301 | 2020-02-18 |
1861042632 | Brenda Grizelda Vargas | Behavioral Analyst | 3400 State Ste Ste G750, Salem, OR 97301 | 2019-09-13 |
1588213177 | Natalie Stone | Registered Nurse | 2045 Siverton Rd Ne, Salem, OR 97301 | 2019-09-06 |
1588228720 | Jeramy Disenso | Counselor | 270 Cottage St Ne, Salem, OR 97301 | 2019-04-23 |
1801353297 | Gwendolyn Kersey | Registered Nurse | 2600 Center St Ne Oregon State Hospital, Salem, OR 97301 | 2019-02-21 |
1841769114 | Spine Clinic PC | Massage Therapist | 1281 Lancaster Drive Ne, Salem, OR 97301 | 2018-11-16 |
1013482132 | Kellie Linn Hansen | Physical Therapist | 4049 Market St Se, Salem, OR 97301 | 2018-10-04 |
Find all providers in zip 97301 |
Taxonomy Code | 363AM0700X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Physician Assistant |
Specialization | Medical |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1285255851 | Darby Samantha Jalbert | Physician Assistant | 2480 Liberty St Ne Ste 110, Salem, OR 97301-8381 | 2020-05-05 |
1639614852 | Gregory Bull | Physician Assistant | 622 Fernwood Dr, Salem, VA 24153-2654 | 2016-12-24 |
1841648862 | Theron J Wiese | Physician Assistant | 1395 Commercial St Se, Salem, OR 97302-4205 | 2016-05-31 |
1922329697 | Charleen Ann Thorburn | Physician Assistant | 22 Keewaydin Dr, Salem, NH 03079-2839 | 2010-06-17 |
1316188006 | Judith A Mitchell | Physician Assistant | 4999 Skyline Rd. S., Salem, OR 97306 | 2009-03-10 |
1215912712 | Amy Gouley | Physician Assistant | 1793 13th St Se, Salem, OR 97302-2541 | 2005-12-07 |
1306827100 | William Earle Williams | Physician Assistant | 1233 Edgewater St Nw, Salem, OR 97304-4049 | 2005-11-08 |
1700485224 | Roderick Mao | Physician Assistant | 159 N Broadway, Salem, NH 03079-2136 | 2020-10-26 |
1447719752 | Christine Nicole Jeffries | Physician Assistant | 360 Church St Se, Salem, OR 97301-3796 | 2019-03-16 |
1265999338 | Brolin Johnson | Physician Assistant | 1793 13th St Se, Salem, OR 97302-2541 | 2019-02-26 |
Find all providers in SALEM |
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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.