Provider Demographics
NPI:1174825517
Name:BIERHAUS, JAIMEE JO (PMHNP)
Entity Type:Individual
Prefix:
First Name:JAIMEE
Middle Name:JO
Last Name:BIERHAUS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2120
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-2120
Mailing Address - Country:US
Mailing Address - Phone:541-274-8640
Mailing Address - Fax:
Practice Address - Street 1:2301 MOUNTAIN VIEW BLVD STE A
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1137
Practice Address - Country:US
Practice Address - Phone:541-274-8640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2023-08-22
Deactivation Date:2023-04-27
Deactivation Code:
Reactivation Date:2023-05-18
Provider Licenses
StateLicense IDTaxonomies
OR201043153RN163W00000X
OR10007642363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse