Provider Demographics
NPI:1083140115
Name:SKREEN, JAMIE L (DO)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:SKREEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:L
Other - Last Name:VITERNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1233 EDGEWATER ST NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-4049
Mailing Address - Country:US
Mailing Address - Phone:503-378-7526
Mailing Address - Fax:503-480-1611
Practice Address - Street 1:1233 EDGEWATER ST NW
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-4049
Practice Address - Country:US
Practice Address - Phone:503-378-7526
Practice Address - Fax:503-588-5815
Is Sole Proprietor?:No
Enumeration Date:2017-05-10
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO195225207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine