Provider Demographics
NPI:1861739534
Name:KLEIN, JENNIE ANNE (RN)
Entity type:Individual
Prefix:MISS
First Name:JENNIE
Middle Name:ANNE
Last Name:KLEIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2623 SE ANKENY ST APT 202
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1766
Mailing Address - Country:US
Mailing Address - Phone:971-506-2003
Mailing Address - Fax:
Practice Address - Street 1:2545 SW TERWILLIGER BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-6302
Practice Address - Country:US
Practice Address - Phone:503-314-6483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200040442RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse