Wallace, Jennifer Lyn

Wallace, Jennifer Lyn is an sole proprietor health care provider with primary practice located at 1235 Se Division St Suite 208, Portland OR 97202-1099. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Wallace, Jennifer Lyn can be contacted via phone (888) 480-1115.

Contact Information

Primary practice address
1235 Se Division St Suite 208 Portland OR 97202-1099
Phone: (888) 480-1115
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MD24427 Oregon

Profile Details

NPI number 1730154154
LBN Legal business name Wallace, Jennifer Lyn
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 20th, 2006
Last updated Mar 18th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1730154154 NPPES
Oregon MEDICAID 232919

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