Healthcare Provider Details

I. General information

NPI: 1518494152
Provider Name (Legal Business Name): JENNIFER LYNNE GUTHRIE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2017
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 NW HIGHWAY 101 STE A
LINCOLN CITY OR
97367-3241
US

IV. Provider business mailing address

PO BOX 1194
CORVALLIS OR
97339-1194
US

V. Phone/Fax

Practice location:
  • Phone: 541-996-7480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberN42002
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number57073
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201901973NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: