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General NPI Number Information
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NPI Number | 1184000911
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Entity Type | Organization
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Legal Business Name | JENNIFER MEANS ND LAC PC
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Dates
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Enumeration Date | 08/04/2015
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Last Update Date | 08/04/2015
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Provider Practice Location Address
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Address Line | 4970 SW MAIN AVE # 100
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City | BEAVERTON
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State | OR
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Zip | 97005-2740
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Country | US
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Telephone | 503-641-6400
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Fax | 503-641-6401
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Provider Business Mailing Address
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Address Line | 4970 SW MAIN AVE # 100
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City | BEAVERTON
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State | OR
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Zip | 97005-2740
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Country | US
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Telephone | 503-641-6400
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Fax | 503-641-6401
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Authorized Official
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Title or Position | OWNER, PRESIDENT, PHYSICIAN
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Name | DR. JENNIFER MEANS
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Credential | ND, MACOM
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Telephone | 503-641-6400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 857
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License Number State | OR
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