Healthcare Provider Details

I. General information

NPI: 1457160640
Provider Name (Legal Business Name): JENNIFER L SPEZZA MS, FNP-C, CWOCN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 NE HALSEY ST
PORTLAND OR
97213-4742
US

IV. Provider business mailing address

14954 SE EL CAMINO WAY
MILWAUKIE OR
97267-3134
US

V. Phone/Fax

Practice location:
  • Phone: 503-215-4646
  • Fax:
Mailing address:
  • Phone: 503-679-6833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10056675
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number70120775
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN61507618
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number200340775RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: