Basic Information
| Provider Information | |||||||||
| NPI: | 1881621381 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LINTZ | ||||||||
| FirstName: | JAN | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3525 HILYARD ST | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974053866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416878581 | ||||||||
| FaxNumber: | 5413431411 | ||||||||
| Practice Location | |||||||||
| Address1: | 3525 HILYARD ST STE 600 | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974053866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416878581 | ||||||||
| FaxNumber: | 5413431411 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 12/02/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 280 | MT | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | PA01323 | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 000095553 | 01 | MT | BCBS PROV NUMBER | OTHER |