NPI 1104369917 · live from the CMS NPI Registry
Jodiey Bondurant, DNP, CPNP-PC/AC, FNP
Nurse Practitioner, Pediatrics in Portland, OR. National Provider Identifier 1104369917, active.
NPI record
| NPI | 1104369917 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner, Pediatrics 363LP0200X |
| Practice location | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239 |
| Practice phone | 503-494-8122 |
| Enumerated | November 28, 2016 |
| Last updated | July 19, 2023 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner, Acute Care | 363LA2100X | 202101747NP-PP (OR) |
| Nurse Practitioner, Family | 363LF0000X | 202101747NP-PP (OR) |
| Nurse Practitioner, Pediatrics | 363LP0200X | AP60689542 (WA) |
| Nurse Practitioner, Pediatrics primary | 363LP0200X | 202101747NP-PP (OR) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.