Individual
JENCINA M BUTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
12518 NE AIRPORT WAY STE 110, PORTLAND, OR 97230-1090
(503) 256-2992
(503) 258-0717
Mailing address
12518 NE AIRPORT WAY STE 110, PORTLAND, OR 97230-1090
(503) 256-2992
(503) 258-0717
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO24488
OR
207Q00000X
Family Medicine Physician
OP00002071
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
210973
DEPT OF LABOR & INDUST
—
05
—
8449662
—
WA
05
—
G8859148
—
OR
Enumeration date
10/10/2006
Last updated
11/10/2011
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