Healthcare Provider Details

I. General information

NPI: 1619862729
Provider Name (Legal Business Name): JANET JENEBA MUSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3787 SW 40TH ST
GRESHAM OR
97080-7981
US

IV. Provider business mailing address

3787 SW 40TH ST # THST
GRESHAM OR
97080-7981
US

V. Phone/Fax

Practice location:
  • Phone: 503-421-6500
  • Fax:
Mailing address:
  • Phone: 619-846-5945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10000785
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2025003586
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: