Provider Demographics
NPI:1760194625
Name:BRENT, JESSIKA ALEXANDREA (DOULA)
Entity Type:Individual
Prefix:
First Name:JESSIKA
Middle Name:ALEXANDREA
Last Name:BRENT
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:JESSIKA
Other - Middle Name:ALEXANDREA
Other - Last Name:RATHBONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 OSAGE ST
Mailing Address - Street 2:
Mailing Address - City:SWEET HOME
Mailing Address - State:OR
Mailing Address - Zip Code:97386-1317
Mailing Address - Country:US
Mailing Address - Phone:503-551-0751
Mailing Address - Fax:
Practice Address - Street 1:200 OSAGE ST
Practice Address - Street 2:
Practice Address - City:SWEET HOME
Practice Address - State:OR
Practice Address - Zip Code:97386-1317
Practice Address - Country:US
Practice Address - Phone:503-551-0751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula