=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538155361
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER NMI KUHN ANP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2005
-----------------------------------------------------
Last Update Date | 12/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1508 DIVISION ST STE 15
-----------------------------------------------------
City | OREGON CITY
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97045-1582
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-692-3750
-----------------------------------------------------
Fax | 503-691-2324
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 541 NE 20TH AVE STE 225
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97232-2895
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-963-2801
-----------------------------------------------------
Fax | 503-963-2825
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 200050087NP
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------