Provider Demographics
NPI:1306953492
Name:BUESSELER, JABKE S (CNM)
Entity type:Individual
Prefix:MS
First Name:JABKE
Middle Name:S
Last Name:BUESSELER
Suffix:
Gender:F
Credentials:CNM
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Mailing Address - Street 1:7650 SW BEVELAND RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8692
Mailing Address - Country:US
Mailing Address - Phone:503-855-1620
Mailing Address - Fax:503-840-3299
Practice Address - Street 1:7431 NE EVERGREEN PKWY
Practice Address - Street 2:STE 100
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5831
Practice Address - Country:US
Practice Address - Phone:503-840-3400
Practice Address - Fax:503-840-3409
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2018-05-08
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Provider Licenses
StateLicense IDTaxonomies
OR200550122NP367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR274289Medicaid
ORR157438OtherMEDICARE PTAN