Healthcare Provider Details

I. General information

NPI: 1619842648
Provider Name (Legal Business Name): JULES JOEL DWELLE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2025
Last Update Date: 10/08/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N GRAHAM ST, MEDICAL OFFICE BLDG 3 STE 420
PORTLAND OR
97227
US

IV. Provider business mailing address

13636 SW PACKARD LN
BEAVERTON OR
97008-6897
US

V. Phone/Fax

Practice location:
  • Phone: 503-276-6154
  • Fax:
Mailing address:
  • Phone: 503-442-6120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number114500
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: