Provider Demographics
NPI:1306387733
Name:FORESMAN, JENNIFER (BSN, DNP, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:FORESMAN
Suffix:
Gender:F
Credentials:BSN, DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 SW MARLOW AVE SUITE 218
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223
Mailing Address - Country:US
Mailing Address - Phone:503-444-4862
Mailing Address - Fax:
Practice Address - Street 1:1815 SW MARLOW AVE STE 218
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5187
Practice Address - Country:US
Practice Address - Phone:503-444-4862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201701845NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health