Healthcare Provider Details

I. General information

NPI: 1184000911
Provider Name (Legal Business Name): JENNIFER MEANS ND LAC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4970 SW MAIN AVE # 100
BEAVERTON OR
97005-2740
US

IV. Provider business mailing address

4970 SW MAIN AVE # 100
BEAVERTON OR
97005-2740
US

V. Phone/Fax

Practice location:
  • Phone: 503-641-6400
  • Fax: 503-641-6401
Mailing address:
  • Phone: 503-641-6400
  • Fax: 503-641-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number857
License Number StateOR

VIII. Authorized Official

Name: DR. JENNIFER MEANS
Title or Position: OWNER, PRESIDENT, PHYSICIAN
Credential: ND, MACOM
Phone: 503-641-6400