Healthcare Provider Details

I. General information

NPI: 1922937820
Provider Name (Legal Business Name): JESSICA JANE ROBINSON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4805 NE GLISAN ST
PORTLAND OR
97213-2933
US

IV. Provider business mailing address

2991 DELLWOOD DR
LAKE OSWEGO OR
97034-6725
US

V. Phone/Fax

Practice location:
  • Phone: 503-215-1111
  • Fax:
Mailing address:
  • Phone: 406-860-8580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number201808733RN
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: