Individual
JENNIFER KAY BANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
511 SW 10TH AVE, SUITE 1301, PORTLAND, OR 97205-2732
(503) 228-0155
(503) 226-8342
Mailing address
511 SW 10TH AVE STE 1301, PORTLAND, OR 97205-2714
(503) 228-0155
(503) 226-8342
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
PA173635
OR
363AM0700X
Medical Physician Assistant
Primary
173635
OR
363AM0700X
Medical Physician Assistant
PA10004564
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2010430
—
WA
Enumeration date
05/12/2010
Last updated
12/13/2019
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