Provider Demographics
NPI:1235376245
Name:JENNIFER MAURER INC.
Entity Type:Organization
Organization Name:JENNIFER MAURER INC.
Other - Org Name:FAMILY TREE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NATUROPATHIC PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MAURER
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-644-6769
Mailing Address - Street 1:1567 SE TACOMA ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-6643
Mailing Address - Country:US
Mailing Address - Phone:503-644-6769
Mailing Address - Fax:503-239-8937
Practice Address - Street 1:1567 SE TACOMA ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-6643
Practice Address - Country:US
Practice Address - Phone:503-644-6769
Practice Address - Fax:503-239-8937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1503175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty