Basic Information
Provider Information
NPI: 1437575149
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GUTHRIE
FirstName: JENNIFER
MiddleName: ANN
NamePrefix:  
NameSuffix:  
Credential: CNM
OtherOrganizationName:  
OtherOrganizationType:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2500 NE NEFF RD
Address2:  
City: BEND
State: OR
PostalCode: 977016015
CountryCode: US
TelephoneNumber: 5413824321
FaxNumber:  
Practice Location
Address1: 340 NW 5TH ST STE 101
Address2:  
City: REDMOND
State: OR
PostalCode: 97756
CountryCode: US
TelephoneNumber: 5413824321
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/06/2014
LastUpdateDate: 05/29/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/29/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367A00000X201401235NP-PPORY Physician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife 

No ID Information.


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