Healthcare Provider Details

I. General information

NPI: 1457791154
Provider Name (Legal Business Name): JENNA EMERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2013
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 N BROADWAY
PORTLAND OR
97227-1800
US

IV. Provider business mailing address

1498 SE TECH CENTER PL STE 240
VANCOUVER WA
98683-5508
US

V. Phone/Fax

Practice location:
  • Phone: 503-280-1223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD197593
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberMD197593
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: