Individual
JENNIFER K. VAN ATTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
15755 SW SEQUOIA PKWY STE 200, TIGARD, OR 97224-7166
(503) 639-6002
(503) 639-1403
Mailing address
15755 SW SEQUOIA PKWY STE 200, TIGARD, OR 97224-7166
(503) 639-6002
(503) 639-1403
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA01150
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001920
—
OR
05
—
500604336
—
OR
01
—
93-1280904
TAX ID
OR
Enumeration date
10/23/2006
Last updated
01/25/2013
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