Basic Information
| Provider Information | |||||||||
| NPI: | 1073565305 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POWER | ||||||||
| FirstName: | JULIETTE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 LANCASTER DR NE | ||||||||
| Address2: | KAISER PERMANENTE | ||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973051221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039822174 | ||||||||
| FaxNumber: | 5039824599 | ||||||||
| Practice Location | |||||||||
| Address1: | 1390 MERIDIAN DR | ||||||||
| Address2: | |||||||||
| City: | WOODBURN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970719668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039822174 | ||||||||
| FaxNumber: | 5039824599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 02/04/2022 | ||||||||
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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 | 207Q00000X | MD23304 | OR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 287241 | 05 | OR | MEDICAID |