Individual
JENNIFER LARNED MACNICHOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1130 NW 22ND AVE, SUITE 220, PORTLAND, OR 97210-2900
(503) 413-8988
Mailing address
PO BOX 3777, PORTLAND, OR 97208-3777
(503) 413-3900
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD14569
OR
Other
Enumeration date
10/28/2009
Last updated
02/03/2010
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