Healthcare Provider Details

I. General information

NPI: 1992660021
Provider Name (Legal Business Name): JENNIFER LAUREN MATSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNY MATSON RN

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 NE 139TH STREET MEDICAL OFFICE BUILDING B, SUITE 150
VANCOUVER WA
98686
US

IV. Provider business mailing address

PO BOX 458
AMBOY WA
98601-0029
US

V. Phone/Fax

Practice location:
  • Phone: 360-487-1855
  • Fax:
Mailing address:
  • Phone: 360-601-5887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number201390106RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License NumberRN60398310
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: