Healthcare Provider Details

I. General information

NPI: 1023057221
Provider Name (Legal Business Name): ROBIN MICHELLE JEWETT P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 COMMERCIAL ST SE # 101-258
SALEM OR
97302-4981
US

IV. Provider business mailing address

6800 SW 105TH AVE STE 206
BEAVERTON OR
97008-5487
US

V. Phone/Fax

Practice location:
  • Phone: 503-896-0297
  • Fax: 877-719-1596
Mailing address:
  • Phone: 503-430-1777
  • Fax: 503-372-5119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA0000001305
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: