MEDICARE: MRS. JENNIFER MOON NP

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	363LF0000X	Family Nurse Practitioner	201707373NP-PP	OR

General Provider Information

NPI Number	:	1073051736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER MOON NP

Provider Business Mailing Address
First Line	:	110 BEAVERCREEK RD
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-4307
Country	:	US
Telephone Number	:	503-655-8471
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 BEAVERCREEK RD
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-4307
Country	:	US
Telephone Number	:	503-655-8471
Fax Number	:

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

Provider Enumeration Date	:	02/02/2017
Last Update Date	:	04/21/2026

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