Healthcare Provider Details

I. General information

NPI: 1386806503
Provider Name (Legal Business Name): JENNIFER LOIS ZITOMER RN,BSN; MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2008
Last Update Date: 06/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16100 SW AUDUBON ST UNIT 103
BEAVERTON OR
97006-2481
US

IV. Provider business mailing address

16100 SW AUDUBON ST UNIT 103
BEAVERTON OR
97006-2481
US

V. Phone/Fax

Practice location:
  • Phone: 503-746-5241
  • Fax:
Mailing address:
  • Phone: 503-746-5241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number200743220RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: