Basic Information
| Provider Information | |||||||||
| NPI: | 1962554543 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEGUIN | ||||||||
| FirstName: | JACKIE | ||||||||
| MiddleName: | KAY | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3725 NE MULTNOMAH ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972321916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032317216 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3231 SE 50TH AVE | ||||||||
| Address2: | PLANNED PARENTHOOD OF THE COLUMBIA WILLAMETTE | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037750861 | ||||||||
| FaxNumber: | 5037887285 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 363L00000X | 000033522N1FNPPP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 263475 | 01 | OR | OMAP | OTHER | 131475 | 01 | PIN | OTHER |