Provider Demographics
NPI:1083438519
Name:HERNANDEZ, JASMIN
Entity type:Individual
Prefix:
First Name:JASMIN
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W MARQUAM ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT ANGEL
Mailing Address - State:OR
Mailing Address - Zip Code:97362-9520
Mailing Address - Country:US
Mailing Address - Phone:503-845-2000
Mailing Address - Fax:503-845-2384
Practice Address - Street 1:250 W MARQUAM ST
Practice Address - Street 2:
Practice Address - City:MOUNT ANGEL
Practice Address - State:OR
Practice Address - Zip Code:97362-9520
Practice Address - Country:US
Practice Address - Phone:503-845-2000
Practice Address - Fax:503-845-2384
Is Sole Proprietor?:No
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker