Provider Demographics
NPI:1316262157
Name:PAGE, JENNINE NICOLE (MD (MBCHB))
Entity type:Individual
Prefix:DR
First Name:JENNINE
Middle Name:NICOLE
Last Name:PAGE
Suffix:
Gender:F
Credentials:MD (MBCHB)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 13TH ST
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-1204
Mailing Address - Country:US
Mailing Address - Phone:541-387-6510
Mailing Address - Fax:
Practice Address - Street 1:811 13TH ST
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-1204
Practice Address - Country:US
Practice Address - Phone:541-387-6510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD162684207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine