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NPI Code Detail

MEDICARE: JENNIFER WILLIS QMHA

MEDICARE: JENNIFER WILLIS QMHA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1003369893
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER WILLIS QMHA
Provider Business Mailing Address
First Line : 14600 NW CORNELL RD
Second Line :
City : PORTLAND
State : OR
Zip : 97229-5442
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 18417 SE OAK ST
Second Line :
City : PORTLAND
State : OR
Zip : 97233-4850
Country : US
Telephone Number : 971-727-8026
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2016
Last Update Date : 07/14/2023

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