Individual
HEATHER JENNINGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
300 N GRAHAM ST STE 125, PORTLAND, OR 97227-1683
(503) 413-3714
Mailing address
501 N GRAHAM ST STE 580, PORTLAND, OR 97227-2003
(503) 528-0704
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA187607
—
363AS0400X
Surgical Physician Assistant
PA187607
OR
Other
Enumeration date
06/25/2018
Last updated
12/12/2019
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