Individual
JERAD R SPENCER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
722 NE 162ND AVE, PORTLAND, OR 97230-5760
(503) 408-4703
(503) 261-0988
Mailing address
722 NE 162ND AVE, PORTLAND, OR 97230-5760
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
201042469RN
OR
Other
Enumeration date
08/26/2010
Last updated
08/26/2010
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