Jennifer Wallace, MD

NPI 1730154154 · on the registry since 2006 · sole proprietor

Practice

Address: 1235 Se Division St
Suite 208
Portland, OR 97202
Phone: (888) 480-1115
Organisation at this address: Gfm Llc
Vital Bodyworks
Justin Long Llc
Aria Walker, Lac
Nora Grod Lac Llc
Inferred from a shared address, not stated in the registry.
Clinicians at this address: 64

Registry record

Primary taxonomy: 207Q00000X
207Q00000X
Licence states on file: OR
From the registry's licence fields, which are often incomplete.
Sex: Female
Record last updated: 2008-03-18

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Oregon