Individual
JENNIFER BOTELHO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1130 NW 22ND AVE STE 535, PORTLAND, OR 97210-2976
(503) 274-4999
Mailing address
1130 NW 22ND AVE STE 535, PORTLAND, OR 97210-2976
(503) 274-4999
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA00838
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
191806
DOLI
OR
05
—
8404378
—
WA
05
—
PA00838
—
OR
Enumeration date
10/05/2005
Last updated
08/26/2011
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