Basic Information
| Provider Information | |||||||||
| NPI: | 1871787804 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JANZEN | ||||||||
| FirstName: | JESSICA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3103 NE 12TH AVE | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972122242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062028735 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5933 NE WIN SIVERS DR STE 305 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972209106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034205852 | ||||||||
| FaxNumber: | 8442764208 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2007 | ||||||||
| LastUpdateDate: | 11/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 42586 | AZ | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 164407 | OR | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.