Individual
DR. JACOB E. CREVISTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DNP, RN, PMHNP-BC
Contact information
Practice address
1308 NW 20TH AVE STE 8, PORTLAND, OR 97209-1607
(971) 213-5986
(503) 405-8124
Mailing address
745 NW HOYT ST UNIT 5482, PORTLAND, OR 97208-8099
(971) 213-5986
(503) 405-8124
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
200841169RN
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
201405518NP-PP
OR
Other
Enumeration date
09/18/2014
Last updated
09/20/2024
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