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NPI Code Detail

MEDICARE: JENNA MARIE WILEY MD

MEDICARE: JENNA MARIE WILEY 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
1207P00000XEmergency Medicine PhysicianMD.MD.70069278WA
2207P00000XEmergency Medicine PhysicianMD198764OR
3390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1558894857
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNA MARIE WILEY MD
Provider Business Mailing Address
First Line : 1015 NW 22ND AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97210-3025
Country : US
Telephone Number : 503-413-7711
Fax Number :
Provider Business Practice Location Address
First Line : 1015 NW 22ND AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97210-3025
Country : US
Telephone Number : 503-413-7711
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2017
Last Update Date : 01/20/2026

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Directions to “ JENNA MARIE WILEY MD” Practice Location

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