Provider Demographics
NPI:1346227972
Name:GIETZEN, JONATHAN WILLIAM (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:WILLIAM
Last Name:GIETZEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:JONATHON
Other - Middle Name:WILLIAM
Other - Last Name:GIETZEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:1209 MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-3301
Mailing Address - Country:US
Mailing Address - Phone:503-359-4358
Mailing Address - Fax:
Practice Address - Street 1:SUNSET KAISER CLINIC
Practice Address - Street 2:10060 NE EVERGREEN PARKWAY
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-1196
Practice Address - Country:US
Practice Address - Phone:503-813-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00694363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant