Healthcare Provider Details

I. General information

NPI: 1548776842
Provider Name (Legal Business Name): HEATHER ANNE JACOBS CNM, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER ANNE SHERIFF

II. Dates (important events)

Enumeration Date: 12/21/2017
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10566 SE WASHINGTON ST
PORTLAND OR
97216-2809
US

IV. Provider business mailing address

500 NE MULTNOMAH ST STE 100
PORTLAND OR
97232-2099
US

V. Phone/Fax

Practice location:
  • Phone: 503-734-3800
  • Fax: 503-734-3808
Mailing address:
  • Phone: 800-813-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number201910478NP-PP
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number201910478NP-PP
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP61054511
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: