Provider Demographics
NPI:1053606137
Name:DONALDSON, JENNA MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:JENNA
Middle Name:MARIE
Last Name:DONALDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:MARIE
Other - Last Name:HAWKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 92900
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97292-0900
Mailing Address - Country:US
Mailing Address - Phone:503-408-7010
Mailing Address - Fax:
Practice Address - Street 1:1002 N BOONES FERRY RD
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-9602
Practice Address - Country:US
Practice Address - Phone:503-981-9526
Practice Address - Fax:503-414-8535
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML 60225319207Q00000X
ORMD167429207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine