Healthcare Provider Details

I. General information

NPI: 1396001517
Provider Name (Legal Business Name): JENNIFER ROSE STEVENS RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 10/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 FAIRVIEW STREET
SILVERTON OR
97381
US

IV. Provider business mailing address

PO BOX 278
WOODBURN OR
97071
US

V. Phone/Fax

Practice location:
  • Phone: 971-983-5360
  • Fax: 971-983-5370
Mailing address:
  • Phone: 971-983-5260
  • Fax: 971-983-5326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201404734NP-PP
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201404734NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: