Provider Demographics
NPI:1891843397
Name:MURDOCH, JENNIFER LYNN (ANP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:MURDOCH
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:MCDONOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9135 SW BARNES RD STE 985
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6699
Mailing Address - Country:US
Mailing Address - Phone:503-297-3336
Mailing Address - Fax:503-297-3338
Practice Address - Street 1:9135 SW BARNES RD STE 985
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6699
Practice Address - Country:US
Practice Address - Phone:503-297-3336
Practice Address - Fax:503-297-3338
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200450072NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MU1150452OtherDEA
MU1150452OtherDEA