Individual
JESSE EDWARD VANDER HEIDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-3273
Mailing address
4230 SW CHESAPEAK AVE, PORTLAND, OR 97239-1345
Taxonomy
Speciality
Code
Description
License number
State
163WP2201X
Ambulatory Care Registered Nurse
Primary
200441630RN
OR
Other
Enumeration date
03/19/2020
Last updated
03/19/2020
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