MEDICARE: JENNIFER RAYNSFORD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	222719	OR

General Provider Information

NPI Number	:	1063231231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER RAYNSFORD

Provider Business Mailing Address
First Line	:	1848 KILLIAN SPRING DR
Second Line	:
City	:	WOODBURN
State	:	OR
Zip	:	97071-5912
Country	:	US
Telephone Number	:	415-577-8482
Fax Number	:

Provider Business Practice Location Address
First Line	:	1848 KILLIAN SPRING DR
Second Line	:
City	:	WOODBURN
State	:	OR
Zip	:	97071-5912
Country	:	US
Telephone Number	:	415-577-8482
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2024
Last Update Date	:	10/05/2024

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