Individual
MR. JEAN-CLAUDE KLEBER PROVOST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
5100 S MACADAM AVE STE 200, PORTLAND, OR 97239-3827
(971) 202-5500
(971) 202-5555
Mailing address
5100 S MACADAM AVE STE 200, PORTLAND, OR 97239-3827
(971) 202-5500
(971) 202-5555
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
200350102NP FNP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022717
—
OR
01
—
067593030
BLUE CROSS/BLUE SHIELD
—
Enumeration date
05/23/2006
Last updated
12/07/2021
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