Healthcare Provider Details

I. General information

NPI: 1174708812
Provider Name (Legal Business Name): JENNIFER SUE BEHNKE APN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER SUE MATZ

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 10/16/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 NW 8TH ST
MCMINNVILLE OR
97128-5560
US

IV. Provider business mailing address

960 NE 28TH ST
MCMINNVILLE OR
97128-2210
US

V. Phone/Fax

Practice location:
  • Phone: 503-379-0208
  • Fax: 503-662-6068
Mailing address:
  • Phone: 503-916-9898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN0000013155
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number200950051NP
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN0000157343
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number200940952RN
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number13155
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: