Individual
MS. JENNY LYNN PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
13317 SE POWELL BLVD, PORTLAND, OR 97236-3335
(503) 760-9606
(503) 760-9609
Mailing address
313 SE 86TH AVE, PORTLAND, OR 97216-1044
(503) 262-0566
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
200141254RN
OR
171M00000X
Case Manager/Care Coordinator
—
OR
Other
Enumeration date
01/30/2007
Last updated
08/03/2016
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