Provider Demographics
NPI:1356392658
Name:SONNELAND, JANE ELLEN (MD)
Entity type:Individual
Prefix:
First Name:JANE ELLEN
Middle Name:
Last Name:SONNELAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6026 N MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-1805
Mailing Address - Country:US
Mailing Address - Phone:503-752-8550
Mailing Address - Fax:
Practice Address - Street 1:6026 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-1805
Practice Address - Country:US
Practice Address - Phone:503-752-8550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD09031207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR213322Medicaid
ORP00604898OtherRR MEDICARE
ORR152444Medicare PIN
ORP00604898OtherRR MEDICARE
ORR152446Medicare PIN
ORR154227Medicare PIN
ORR141818Medicare PIN
OR213322Medicaid
ORR144976Medicare PIN
ORR152447Medicare PIN
ORR135315Medicare PIN