Individual
JEREMY MICHAEL GOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
1225 NE 2ND AVE, PORTLAND, OR 97232-2003
(503) 413-4100
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
201809282RN
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
202005741NP-PP
OR
Other
Enumeration date
01/31/2019
Last updated
07/14/2020
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