Provider Demographics
NPI:1083694376
Name:O'CONNOR, JENNIFER CATHERINE (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:CATHERINE
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2101 NE 139TH ST
Mailing Address - Street 2:STE 350
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-2309
Mailing Address - Country:US
Mailing Address - Phone:360-256-4060
Mailing Address - Fax:360-256-0103
Practice Address - Street 1:2101 NE 139TH ST
Practice Address - Street 2:STE 350
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-2309
Practice Address - Country:US
Practice Address - Phone:360-256-4060
Practice Address - Fax:360-256-0103
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAOP00001989207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8253957Medicaid
WAG8855712Medicare PIN
I40355Medicare UPIN