Healthcare Provider Details

I. General information

NPI: 1225969959
Provider Name (Legal Business Name): JENNIFER LOUISE LEWELLYN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3011 E BARNETT RD
MEDFORD OR
97504-8301
US

IV. Provider business mailing address

8725 JOHN DAY DR
GOLD HILL OR
97525-5524
US

V. Phone/Fax

Practice location:
  • Phone: 541-789-0462
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number201043076RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: