Provider Demographics
NPI:1932548161
Name:ESTERBERG, JENNA LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LEE
Last Name:ESTERBERG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:LEE
Other - Last Name:CURTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4400 NE HALSEY ST.
Mailing Address - Street 2:POP 2- 4TH FLOOR
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213
Mailing Address - Country:US
Mailing Address - Phone:503-893-6361
Mailing Address - Fax:503-893-6891
Practice Address - Street 1:24076 SE STARK ST
Practice Address - Street 2:SUITE 230
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3373
Practice Address - Country:US
Practice Address - Phone:503-488-2600
Practice Address - Fax:503-465-5468
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA162183363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500660295Medicaid
WA1932548161Medicaid
WA1932548161Medicaid
OR500660295Medicaid