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General NPI Number Information
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NPI Number | 1700016698
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Entity Type | Individual
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Provider Name | JEREMIAH LEE ELDRED APRN
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Gender | Male
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Dates
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Enumeration Date | 07/25/2009
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Last Update Date | 03/31/2020
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Provider Practice Location Address
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Address Line | 1350 NE 122ND AVE
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City | PORTLAND
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State | OR
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Zip | 97230-2011
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Country | US
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Telephone | 503-408-7008
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Fax | 503-408-7045
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Provider Business Mailing Address
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Address Line | PO BOX 92900
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City | PORTLAND
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State | OR
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Zip | 97292-0900
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Country | US
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Telephone | 360-608-9017
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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 | RN39486
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 201150192NP
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License Number State | OR
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