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General NPI Number Information
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NPI Number | 1295823847
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Entity Type | Individual
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Provider Name | JENCINA M BUTLER DO
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Gender | Female
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 11/10/2011
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Provider Practice Location Address
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Address Line | 12518 NE AIRPORT WAY STE 110
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City | PORTLAND
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State | OR
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Zip | 97230-1090
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Country | US
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Telephone | 503-256-2992
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Fax | 503-258-0717
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Provider Business Mailing Address
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Address Line | 12518 NE AIRPORT WAY STE 110
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City | PORTLAND
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State | OR
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Zip | 97230-1090
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Country | US
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Telephone | 503-256-2992
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Fax | 503-258-0717
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OP00002071
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO24488
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License Number State | OR
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