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NPI Code Detail

MEDICARE: JENNIFER LEE NYGAARD RN

MEDICARE: JENNIFER LEE NYGAARD RN
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
1163WP2201XAmbulatory Care Registered Nurse200642708RNOR

General Provider Information

NPI Number : 1417813585
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER LEE NYGAARD RN
Provider Business Mailing Address
First Line : 2265 EXCHANGE ST
Second Line :
City : ASTORIA
State : OR
Zip : 97103-3331
Country : US
Telephone Number : 503-338-4075
Fax Number : 503-338-4076
Provider Business Practice Location Address
First Line : 2265 EXCHANGE ST
Second Line :
City : ASTORIA
State : OR
Zip : 97103-3331
Country : US
Telephone Number : 503-338-4075
Fax Number : 503-338-4076
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/01/2026
Last Update Date : 01/01/2026

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