Provider Demographics
NPI:1912762949
Name:JEROME, JERUSHA ANN (RN)
Entity Type:Individual
Prefix:
First Name:JERUSHA
Middle Name:ANN
Last Name:JEROME
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:JERUSHA
Other - Middle Name:ANN
Other - Last Name:CANNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5335 SE 13TH CT
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-2906
Mailing Address - Country:US
Mailing Address - Phone:503-334-7531
Mailing Address - Fax:
Practice Address - Street 1:500 NE MULTNOMAH ST FL 7
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2023
Practice Address - Country:US
Practice Address - Phone:503-261-2090
Practice Address - Fax:503-261-2040
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200241525RN163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy