Provider Demographics
NPI:1922724004
Name:MONTENEGRO, JXXN RENEE (ND)
Entity Type:Individual
Prefix:
First Name:JXXN
Middle Name:RENEE
Last Name:MONTENEGRO
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:RENEE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ND
Mailing Address - Street 1:17397 SW CARSON CT
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97078-1380
Mailing Address - Country:US
Mailing Address - Phone:503-757-6686
Mailing Address - Fax:928-316-6316
Practice Address - Street 1:819 SE MORRISON ST STE 235
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-6312
Practice Address - Country:US
Practice Address - Phone:503-757-6686
Practice Address - Fax:503-908-6742
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4479175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath