Provider Demographics
NPI:1629490891
Name:EVANS, JESSICA M (ND)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:M
Last Name:EVANS
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:15110 BOONES FERRY RD
Mailing Address - Street 2:STE 380
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3468
Mailing Address - Country:US
Mailing Address - Phone:503-675-2439
Mailing Address - Fax:503-210-0913
Practice Address - Street 1:15110 BOONES FERRY RD
Practice Address - Street 2:STE 380
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3468
Practice Address - Country:US
Practice Address - Phone:503-675-2439
Practice Address - Fax:503-210-0913
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2014175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath