Provider Demographics
NPI:1992153365
Name:POTTS, JANELLE (CNM)
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:POTTS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:JANELLE
Other - Middle Name:
Other - Last Name:SELVIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:7650 SW BEVELAND RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8692
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:364 SE 8TH AVE STE 205
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4249
Practice Address - Country:US
Practice Address - Phone:503-681-4250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201042881RN163W00000X
OR201603547NP-PP367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500708283Medicaid
ORR190127OtherMEDICARE PTAN