Individual
JENNA PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
19300 SW 65TH AVE, TUALATIN, OR 97062-7706
(503) 525-7660
Mailing address
9 W FRANKLIN AVE APT 306, MINNEAPOLIS, MN 55404-2594
(509) 481-3217
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
63421
MN
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
MD203919
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/24/2016
Last updated
07/08/2021
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