Healthcare Provider Details

I. General information

NPI: 1124851811
Provider Name (Legal Business Name): JESSICA ANNE HARGADINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24850 SE STARK ST STE 200
GRESHAM OR
97030-8320
US

IV. Provider business mailing address

1416 C ST
WASHOUGAL WA
98671-2332
US

V. Phone/Fax

Practice location:
  • Phone: 503-491-9444
  • Fax:
Mailing address:
  • Phone: 406-498-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number10031483
License Number State
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number10031483
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: