Healthcare Provider Details

I. General information

NPI: 1083812754
Provider Name (Legal Business Name): JADENE HENDRICKS-JENSEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JADENE HENDRICKS

II. Dates (important events)

Enumeration Date: 07/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 SW US VETERANS HOSPITAL RD
PORTLAND OR
97239-2964
US

IV. Provider business mailing address

16343 SW SIENNA LN
BEAVERTON OR
97007-8801
US

V. Phone/Fax

Practice location:
  • Phone: 503-279-5055
  • Fax:
Mailing address:
  • Phone: 503-579-4508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: