Healthcare Provider Details

I. General information

NPI: 1760463699
Provider Name (Legal Business Name): JENNIFER L. GIBBONS ND
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10360 NE WASCO ST
PORTLAND OR
97220-3927
US

IV. Provider business mailing address

1137 SE 88TH AVE
PORTLAND OR
97216-1705
US

V. Phone/Fax

Practice location:
  • Phone: 503-252-8125
  • Fax:
Mailing address:
  • Phone: 503-252-4669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number959
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: