Most Relevant Information
Provider Data
| NPI Number: | 1003437617 |
| Provider Name: | JENNIFER MARIE PROVINCE |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 202007639NP-PP |
Most Important Dates
| Enumeration Date: | 05/05/2020 |
| Last Updated: | 09/02/2020 |
Provider Practice Location
1 UNIVERSITY BLVD
LA GRANDE
OR
978502807
Practice Location Phone/Fax
| Phone: | 5419623803 |
| Fax: |
Provider Mailing Location
2011 4TH ST
LA GRANDE
OR
978502511
Provider Mailing Phone/Fax
| Phone: | 5419627808 |
| Fax: | 5419620860 |