Provider Demographics
NPI:1811478928
Name:WERTHEIM, JENNA SUSANNE (RN)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:SUSANNE
Last Name:WERTHEIM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2558 TROY CT
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-7306
Mailing Address - Country:US
Mailing Address - Phone:805-259-7554
Mailing Address - Fax:
Practice Address - Street 1:2558 TROY CT
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-7306
Practice Address - Country:US
Practice Address - Phone:180-525-9755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201806456RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse