Individual provider · Type 1 NPI

Jennifer Justina Clark, FNP-BC

Family Nurse Practitioner · Portland, OR

NPI number 1417596016 Active

Practice location

3710 SW US Veterans Hospital Rd
Portland, OR 97239-2964

Mailing address

476 SW Park St
Camas, WA 98607-2633

Specialties and licenses

TaxonomyCodeLicense
Family Nurse Practitioner 363LF0000XAP61006464 (WA)
Family Nurse Practitioner Primary 363LF0000X201908784NP-PP (OR)

Family Nurse Practitioner: Definition to come...

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About NPI 1417596016

Jennifer Justina Clark, FNP-BC's National Provider Identifier is 1417596016, issued on Dec 30, 2019. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Portland, OR. The record was last updated on Dec 30, 2019.