Healthcare Provider Details

I. General information

NPI: 1124482070
Provider Name (Legal Business Name): JENNIFER DAMORE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 04/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 NW BEAVER ST SUITE 100
PRINEVILLE OR
97754-1802
US

IV. Provider business mailing address

1958 NE OTELAH PL
BEND OR
97701-6123
US

V. Phone/Fax

Practice location:
  • Phone: 541-447-5165
  • Fax:
Mailing address:
  • Phone: 317-331-0602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number201600812NP-PP
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number201600813NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: