Provider Demographics
NPI:1821829755
Name:TJERNLUND, ZACHARY SPENCER
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:SPENCER
Last Name:TJERNLUND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-2734
Mailing Address - Country:US
Mailing Address - Phone:541-908-2246
Mailing Address - Fax:
Practice Address - Street 1:3485 S BOND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4503
Practice Address - Country:US
Practice Address - Phone:503-494-6594
Practice Address - Fax:503-418-9719
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10033278363LA2100X
OR201140201163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WX0200XNursing Service ProvidersRegistered NurseOncology