Healthcare Provider Details

I. General information

NPI: 1932548161
Provider Name (Legal Business Name): JENNA LEE ESTERBERG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNA LEE CURTIS PA-C

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 03/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24076 SE STARK ST SUITE 230
GRESHAM OR
97030-3373
US

IV. Provider business mailing address

4400 NE HALSEY ST. POP 2- 4TH FLOOR
PORTLAND OR
97213
US

V. Phone/Fax

Practice location:
  • Phone: 503-488-2600
  • Fax: 503-465-5468
Mailing address:
  • Phone: 503-893-6361
  • Fax: 503-893-6891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA162183
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: