Individual
JENNIFER ANNE LIETZKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2935 SW CEDAR HILLS BLVD, BEAVERTON, OR 97005-1342
(503) 352-6000
(503) 352-6080
Mailing address
PO BOX 6149, BEAVERTON, OR 97007-0149
(503) 352-8657
(503) 352-8658
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD28993
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500634215
—
OR
Enumeration date
06/23/2006
Last updated
02/06/2018
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