Individual
JENNIE MICHELLE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
14743 NW GLACIER LN, BEAVERTON, OR 97006-5892
(503) 443-8339
Mailing address
14743 NW GLACIER LN, BEAVERTON, OR 97006-5892
(503) 443-8339
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
201808713NP-PP
OR
Other
Enumeration date
11/01/2017
Last updated
05/09/2024
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