Individual
JANNELLE MARIE FUKUJI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9495 SW LOCUST ST, SUITE A, PORTLAND, OR 97223-6683
(503) 696-9011
(503) 696-3952
Mailing address
9495 SW LOCUST ST, SUITE A, PORTLAND, OR 97223-6683
(503) 696-9011
(503) 696-3952
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA171607
OR
Other
Enumeration date
12/22/2011
Last updated
03/26/2019
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