Individual
MS. JESSICA ANNE DEJONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1111 NE 99TH AVE STE 201, PORTLAND, OR 97220-9442
(503) 962-1000
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA200546
OR
363AM0700X
Medical Physician Assistant
PA200546
OR
Other
Enumeration date
11/02/2020
Last updated
03/09/2021
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