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NPI Code Detail

MEDICARE: MS. JESSICA M GUNN PA-C

MEDICARE: MS. JESSICA M GUNN PA-C
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
1363A00000XPhysician AssistantPA60881550WA
2363A00000XPhysician AssistantPA186396OR

General Provider Information

NPI Number : 1750797270
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JESSICA M GUNN PA-C
Provider Business Mailing Address
First Line : 520 MAIN ST
Second Line :
City : DOWAGIAC
State : MI
Zip : 49047-1762
Country : US
Telephone Number : 269-783-3052
Fax Number : 269-783-2063
Provider Business Practice Location Address
First Line : 3060 SE HAWTHORNE BLVD STE 1
Second Line :
City : PORTLAND
State : OR
Zip : 97214-4121
Country : US
Telephone Number : 800-813-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2014
Last Update Date : 12/21/2021

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