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General NPI Number Information
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NPI Number | 1033839006
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Entity Type | Individual
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Provider Name | JANE ERIN PETR
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Gender | Female
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Dates
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Enumeration Date | 08/31/2022
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 3303 S BOND AVE
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City | PORTLAND
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State | OR
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Zip | 97239-4501
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Country | US
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Telephone | 34-946-5945
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Fax | 503-494-5385
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Provider Business Mailing Address
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Address Line | 1400 SW 5TH AVE STE 500
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City | PORTLAND
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State | OR
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Zip | 97201-5537
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Country | US
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Telephone |
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Fax | 503-346-8015
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA219625
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License Number State | OR
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