Individual
JENNIFER PENFIELD NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
2111 NE 25TH AVE INTEL HEALTH FOR LIFE CENTER, MS:JF-167, HILLSBORO, OR 97124
(503) 264-8315
(503) 264-0559
Mailing address
1945 NE JAMIE DR., HILLSBORO, OR 97124
(503) 679-9460
(971) 327-4356
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA00813
OR
363AM0700X
Medical Physician Assistant
Primary
00813
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500617236
—
OR
Enumeration date
08/01/2006
Last updated
01/03/2020
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