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NPI Code Detail

MEDICARE: JESSICA RAE GNIADEK PMHNP

MEDICARE: JESSICA RAE GNIADEK PMHNP
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner10033268OR

General Provider Information

NPI Number : 1033677109
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA RAE GNIADEK PMHNP
Provider Business Mailing Address
First Line : 8915 SW CENTER ST
Second Line :
City : TIGARD
State : OR
Zip : 97223-6307
Country : US
Telephone Number : 503-726-3690
Fax Number :
Provider Business Practice Location Address
First Line : 8915 SW CENTER ST
Second Line :
City : TIGARD
State : OR
Zip : 97223-6307
Country : US
Telephone Number : 503-726-3690
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2019
Last Update Date : 03/02/2026

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