MEDICARE: DR. JENNA MARIE DONALDSON MD

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
1	207Q00000X	Family Medicine Physician	ML 60225319	WA
2	207Q00000X	Family Medicine Physician	MD167429	OR

General Provider Information

NPI Number	:	1053606137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNA MARIE DONALDSON MD

Provider Business Mailing Address
First Line	:	PO BOX 92900
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97292-0900
Country	:	US
Telephone Number	:	503-408-7010
Fax Number	:

Provider Business Practice Location Address
First Line	:	1002 N BOONES FERRY RD
Second Line	:
City	:	WOODBURN
State	:	OR
Zip	:	97071-9602
Country	:	US
Telephone Number	:	503-981-9526
Fax Number	:	503-414-8535

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2011
Last Update Date	:	01/21/2019

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