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General NPI Number Information
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NPI Number | 1477026342
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Entity Type | Individual
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Provider Name | JAMIANNE MOORE
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Gender | Female
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Dates
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Enumeration Date | 01/03/2019
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 4713 N ALBINA AVE UNIT 301
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City | PORTLAND
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State | OR
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Zip | 97217-2605
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Country | US
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Telephone | 503-850-2474
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Fax |
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Provider Business Mailing Address
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Address Line | 700 NE 87TH AVE
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City | VANCOUVER
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State | WA
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Zip | 98664-4896
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Country | US
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Telephone | 360-882-2778
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA61309256
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 7390
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA218023
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License Number State | OR
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