Healthcare Provider Details

I. General information

NPI: 1851026314
Provider Name (Legal Business Name): DANIELLE RENE JERNBERG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE RENE HITE

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 NW SAMARITAN DR STE 201
CORVALLIS OR
97330-3785
US

IV. Provider business mailing address

PO BOX 1189
CORVALLIS OR
97339-1189
US

V. Phone/Fax

Practice location:
  • Phone: 541-768-6300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number212794
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: