Provider Demographics
NPI:1467742205
Name:ROBERSON, JENNIFER LYNDA (WHCNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNDA
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12550 SW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-0519
Mailing Address - Country:US
Mailing Address - Phone:503-846-6689
Mailing Address - Fax:503-846-6658
Practice Address - Street 1:12550 SW 2ND ST
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-0519
Practice Address - Country:US
Practice Address - Phone:503-846-6689
Practice Address - Fax:503-846-6658
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR091007328N7 WHCNP-PP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health