Provider Demographics
NPI:1043409030
Name:DUMITRU, JESSICA EVONNE (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:EVONNE
Last Name:DUMITRU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1200 NE 48TH AVE
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-4904
Mailing Address - Country:US
Mailing Address - Phone:503-844-8219
Mailing Address - Fax:503-844-8234
Practice Address - Street 1:421 SE WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4140
Practice Address - Country:US
Practice Address - Phone:503-352-1141
Practice Address - Fax:503-352-1147
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA01284363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR13966Medicare PIN