Mrs Jacqueline Marie Pendergrass, LPN is a
Licensed Practical Nurse based in Florence, Oregon. Mrs Jacqueline Marie Pendergrass is licensed to practice in Oregon (license number 200630279LPN) and her current practice location is
1255 Laurel Street, Florence, Oregon. She can be reached at her office (for appointments etc.) via phone at
(541) 997-4015.
NPI number for Mrs Jacqueline Marie Pendergrass is 1447570437 and her current mailing address is Po Box 1839, Florence, Oregon. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1447570437.
Provider's Profile
Full Name | Mrs Jacqueline Marie Pendergrass |
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Gender | Female |
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Speciality | Licensed Practical Nurse |
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Location | 1255 Laurel Street, Florence, Oregon |
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Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
NPI Data:
- NPI Number: 1447570437
- Provider Enumeration Date: 06/02/2010
- Last Update Date: 12/27/2010
Medical Identifiers
Medical identifiers for Mrs Jacqueline Marie Pendergrass such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1447570437 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
164W00000X | Licensed Practical Nurse | 200630279LPN (Oregon) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mrs Jacqueline Marie Pendergrass is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Mrs Jacqueline Marie Pendergrass, LPN Po Box 1839, Florence, OR 97439-0119 Ph: (541) 997-4015 | Mrs Jacqueline Marie Pendergrass, LPN 1255 Laurel Street, Florence, OR 97439-0119 Ph: (541) 997-4015 |
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