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General NPI Number Information
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NPI Number | 1609670306
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Entity Type | Individual
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Provider Name | JESSICA ALEXANDRA SUM SIQUINA NP
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Gender | Female
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Dates
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Enumeration Date | 04/02/2025
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 1585 N PACIFIC HWY STE E
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City | WOODBURN
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State | OR
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Zip | 97071-3665
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Country | US
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Telephone | 503-510-8135
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Fax |
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Provider Business Mailing Address
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Address Line | 8745 SUNNYVIEW RD NE
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City | SALEM
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State | OR
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Zip | 97305-9549
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Country | US
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Telephone | 503-830-8707
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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 | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 10042713
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License Number State | OR
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