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General NPI Number Information
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NPI Number | 1235823857
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Entity Type | Individual
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Provider Name | JADE FUNTANILLA KEKAUALUA FNP
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Gender | Female
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Dates
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Enumeration Date | 06/06/2023
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 9205 SW BARNES RD STE 861
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City | PORTLAND
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State | OR
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Zip | 97225-6603
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Country | US
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Telephone | 503-216-1234
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Fax |
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Provider Business Mailing Address
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Address Line | 9205 SW BARNES RD STE 861
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City | PORTLAND
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State | OR
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Zip | 97225-6603
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Country | US
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Telephone | 503-216-1234
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 10018910
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License Number State | OR
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