Provider Demographics
NPI:1023057221
Name:JEWETT, ROBIN MICHELLE (PA-C)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:MICHELLE
Last Name:JEWETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 SW 105TH AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-5487
Mailing Address - Country:US
Mailing Address - Phone:503-430-1777
Mailing Address - Fax:503-372-5119
Practice Address - Street 1:2755 COMMERCIAL ST SE # 101-258
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4981
Practice Address - Country:US
Practice Address - Phone:503-896-0297
Practice Address - Fax:877-719-1596
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000001305363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
3663963Medicare ID - Type Unspecified
TNQ61169Medicare UPIN