Provider Demographics
NPI:1114328085
Name:OWENS, JESSICA ANN (LPN)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:ANN
Last Name:OWENS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:ANN
Other - Last Name:ALDERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2702 SE 174TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-1006
Mailing Address - Country:US
Mailing Address - Phone:503-309-6495
Mailing Address - Fax:
Practice Address - Street 1:14516 E BURNSIDE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-2142
Practice Address - Country:US
Practice Address - Phone:503-253-9041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201230150LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse