Individual
DR. JENNIFER L WILLINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
51377 SW OLD PORTLAND RD, SCAPPOOSE, OR 97056-4023
(503) 418-4222
Mailing address
51377 SW OLD PORTLAND RD, SCAPPOOSE, OR 97056-4023
(503) 418-4222
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0420010400
VT
207Q00000X
Family Medicine Physician
Primary
MD181506
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1008992
—
VT
01
—
365938
MVP
VT
01
—
58976
BLUE CROSS BLUE SHIELD
VT
Enumeration date
12/21/2005
Last updated
05/19/2017
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