Individual
JACQUELYN L WELBORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
727 S WAHANNA RD, SEASIDE, OR 97138-7735
(503) 717-7060
Mailing address
PO BOX 3397, PORTLAND, OR 97208-3397
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
201907444NP-PP
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
201907444NP-PP
OR
Other
Enumeration date
08/05/2019
Last updated
02/02/2023
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