Provider Demographics
NPI:1992396055
Name:GOETZ, JESSICA EDEN
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:EDEN
Last Name:GOETZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 NE FREMONT DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-5340
Mailing Address - Country:US
Mailing Address - Phone:503-860-7886
Mailing Address - Fax:
Practice Address - Street 1:2655 NE FREMONT DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-5340
Practice Address - Country:US
Practice Address - Phone:503-860-7886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty