Provider Demographics
NPI:1730358250
Name:PURSELL, JENNIFER JILL (ND, LAC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:JILL
Last Name:PURSELL
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3327 SE HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-5046
Mailing Address - Country:US
Mailing Address - Phone:503-234-7801
Mailing Address - Fax:
Practice Address - Street 1:3327 SE HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-5046
Practice Address - Country:US
Practice Address - Phone:503-234-7801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1607175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath