Individual
STEPHANIE LYNN JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
5000 N WILLAMETTE BLVD, PORTLAND, OR 97203-5798
(503) 943-8000
Mailing address
1331 SW CARSON ST, PORTLAND, OR 97219-4332
(503) 351-8803
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
200842440RN
OR
363LF0000X
Family Nurse Practitioner
Primary
202106433NP-PP
OR
Other
Enumeration date
07/31/2019
Last updated
07/08/2021
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