MEDICARE: JENNY FEDESCO

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	163W00000X	Registered Nurse	201803915RN	OR

General Provider Information

NPI Number	:	1912861303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY FEDESCO

Provider Business Mailing Address
First Line	:	12400 SE FREEMAN WAY
Second Line	:
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-4611
Country	:	US
Telephone Number	:	503-353-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3606 SE LAKE RD
Second Line	:
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-6949
Country	:	US
Telephone Number	:	503-353-5727
Fax Number	:

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

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	12/11/2025

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Directions to “ JENNY FEDESCO ” Practice Location

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