Provider Demographics
NPI:1457834848
Name:TAGESON-RAMIREZ, JESANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:JESANNE
Middle Name:
Last Name:TAGESON-RAMIREZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 COMMERCIAL ST SE STE 320
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4173
Mailing Address - Country:US
Mailing Address - Phone:503-399-8105
Mailing Address - Fax:
Practice Address - Street 1:925 COMMERCIAL ST SE STE 320
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4173
Practice Address - Country:US
Practice Address - Phone:503-399-8105
Practice Address - Fax:503-581-5351
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant