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:
Health care specialties
| Specialty | Code | License # | 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 16 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1730154154 | NPPES |
| Oregon | MEDICAID | 232919 |
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