Healthcare Provider Details

I. General information

NPI: 1083694376
Provider Name (Legal Business Name): JENNIFER CATHERINE O'CONNOR DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 NE 139TH ST STE 350
VANCOUVER WA
98686-2309
US

IV. Provider business mailing address

2101 NE 139TH ST STE 350
VANCOUVER WA
98686-2309
US

V. Phone/Fax

Practice location:
  • Phone: 360-256-4060
  • Fax: 360-256-0103
Mailing address:
  • Phone: 360-256-4060
  • Fax: 360-256-0103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberOP00001989
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: