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NPI Code Detail

MEDICARE: JENNIFER ANN GAULT FNP-C, MSN, RN

MEDICARE: JENNIFER ANN GAULT FNP-C, MSN, RN
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
1363L00000XNurse Practitioner10027962OR

General Provider Information

NPI Number : 1831654995
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER ANN GAULT FNP-C, MSN, RN
Provider Business Mailing Address
First Line : 4550 KRUSE WAY STE 125
Second Line :
City : LAKE OSWEGO
State : OR
Zip : 97035-3533
Country : US
Telephone Number : 503-360-7650
Fax Number :
Provider Business Practice Location Address
First Line : 4550 KRUSE WAY STE 125
Second Line :
City : LAKE OSWEGO
State : OR
Zip : 97035-3533
Country : US
Telephone Number : 503-360-7650
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/04/2019
Last Update Date : 02/10/2026

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Directions to “ JENNIFER ANN GAULT FNP-C, MSN, RN” Practice Location

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