Provider Demographics
NPI:1902032071
Name:ODDO, JESSICA J (FNP)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:J
Last Name:ODDO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 NE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4333
Mailing Address - Country:US
Mailing Address - Phone:541-388-7799
Mailing Address - Fax:541-317-0533
Practice Address - Street 1:1302 NE 3RD ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4333
Practice Address - Country:US
Practice Address - Phone:541-388-7799
Practice Address - Fax:541-317-0533
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200950009NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner