Provider Demographics
NPI:1639546203
Name:AEBISCHER, JONATHAN HUBERT (FNP)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:HUBERT
Last Name:AEBISCHER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2818 SW 1ST AVE
Mailing Address - Street 2:APARTMENT B
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-4718
Mailing Address - Country:US
Mailing Address - Phone:503-348-8379
Mailing Address - Fax:
Practice Address - Street 1:19220 MCLOUGHLIN BLVD
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:OR
Practice Address - Zip Code:97027-2642
Practice Address - Country:US
Practice Address - Phone:503-655-2404
Practice Address - Fax:503-655-1581
Is Sole Proprietor?:No
Enumeration Date:2015-08-30
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201505929NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily