Jacquelyn Rose Quetal
Nurse Practitioner - Family Medicine
12710 Se Division St
Portland
, Oregon 97236-3134
Jacquelyn Rose Quetal
Nurse Practitioner - Family Medicine
12710 Se Division St
Portland
, Oregon 97236-3134
(503) 988-3015
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About
Features
Specialties
- Nurse Practitioner - Family Medicine
Languages spoken
- English
Location
First Address
- Jacquelyn Rose Quetal
- 421 Sw Oak St Ste.210
- Portland, OR
- Zip : 97204-1817
- Fax : (503) 988-3015
- Phone : (503) 988-3663
Second Address
- Jacquelyn Rose Quetal
- 12710 Se Division St
- Portland, OR
- Zip : 97236-3134
- Fax : (503) 988-3015
- Phone : (503) 988-3663
Reviews
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Is Jacquelyn Rose Quetal a sole practitioner?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 363LF0000X | Nurse Practitioner - Family Medicine | 1368 | HI |
| Y | 363LF0000X | Nurse Practitioner - Family Medicine | 200950072NP | OR |
National Provider Identifier
| NPI | 1003061292 |
|---|---|
| Provider Name | Jacquelyn Rose Quetal |
| First Address | Portland, OR 97204-1817 |
| Second Address | Portland, OR 97236-3134 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 01/12/2008 |
| Last Update Date | 07/03/2013 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 22959 | (05) | OR |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.