Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 201607115NP-PP | OR |
NPI | 1003350505 |
---|---|
Provider Name | Jennifer Nicole Herr |
First Address | Portland, OR 97208-3158 |
Second Address | Portland, OR 97213-2955 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2016 |
Last Update Date | 02/10/2020 |