Provider Demographics
NPI:1770820532
Name:JESS, TERRY EDWARD (RN)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:EDWARD
Last Name:JESS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:MR
Other - First Name:TERRY
Other - Middle Name:EDWARD
Other - Last Name:JESS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:8512 SE 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-7106
Mailing Address - Country:US
Mailing Address - Phone:503-235-9032
Mailing Address - Fax:
Practice Address - Street 1:8512 SE 13TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-7106
Practice Address - Country:US
Practice Address - Phone:503-235-9032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-13
Last Update Date:2013-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR098007230 RN163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health