Provider Demographics
NPI:1528640174
Name:PEASE, JAMIE SUE (PA-C)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:SUE
Last Name:PEASE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-1701
Mailing Address - Country:US
Mailing Address - Phone:503-883-8297
Mailing Address - Fax:
Practice Address - Street 1:2920 COMMERCIAL ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4552
Practice Address - Country:US
Practice Address - Phone:541-641-6053
Practice Address - Fax:541-485-9987
Is Sole Proprietor?:No
Enumeration Date:2021-04-23
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORPA206023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program