Healthcare Provider Details

I. General information

NPI: 1942575642
Provider Name (Legal Business Name): JO M JENNER ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4840 FISH HATCHERY RD
GRANTS PASS OR
97527-9592
US

IV. Provider business mailing address

4840 FISH HATCHERY RD
GRANTS PASS OR
97527-9592
US

V. Phone/Fax

Practice location:
  • Phone: 541-488-1024
  • Fax:
Mailing address:
  • Phone: 541-488-1024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number697
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: