Individual
JESSICA E LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1350 NE 122ND AVE, PORTLAND, OR 97230-2011
(503) 408-7010
(503) 408-7035
Mailing address
1350 NE 122ND AVE, PORTLAND, OR 97230-2011
(503) 408-7010
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
202215573RN
OR
363LF0000X
Family Nurse Practitioner
Primary
10047531
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202215573RN
OSBN RN
OR
Enumeration date
11/07/2022
Last updated
09/22/2025
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