Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | MD197593 | OR |
Y | 207VX0201X | Gynecologic Oncologist | MD197593 | OR |
NPI | 1457791154 |
---|---|
Provider Name | Jenna Emerson |
First Address | Portland, OR 97239-3011 |
Second Address | Portland, OR 97239-3011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2013 |
Last Update Date | 11/09/2020 |