Individual
MR. JEREMIAH LEE ELDRED
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
1350 NE 122ND AVE, PORTLAND, OR 97230-2011
(503) 408-7008
(503) 408-7045
Mailing address
PO BOX 92900, PORTLAND, OR 97292-0900
(360) 608-9017
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
201150192NP
OR
363LF0000X
Family Nurse Practitioner
RN39486
MT
Other
Enumeration date
07/25/2009
Last updated
03/31/2020
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