Provider Demographics
NPI:1760108377
Name:MONAHAN, JESSICA WOODSIDE (APRN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:WOODSIDE
Last Name:MONAHAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:SARAH
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1002 NW 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-7978
Mailing Address - Country:US
Mailing Address - Phone:530-913-5398
Mailing Address - Fax:
Practice Address - Street 1:9895 SE SUNNYSIDE RD STE F
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9745
Practice Address - Country:US
Practice Address - Phone:971-300-0654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-14
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202007707RN163W00000X
OR10006008363LF0000X
WA61410145363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR202007707RNOtherOREGON STATE LICENSE NUMBER