Individual
MRS. JENNIFER GOODRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP-BC
Contact information
Practice address
9205 SW BARNES RD, PORTLAND, OR 97225-6603
(503) 216-1234
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
201807115NP-PP
OR
363LG0600X
Gerontology Nurse Practitioner
Primary
201807115NP-PP
OR
Other
Enumeration date
08/13/2018
Last updated
01/29/2021
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