Jesse Edward Vander Heide

Primary specialty

Ambulatory Care Registered NurseTaxonomy code 163WP2201X

License

200441630RN Issued in OR

Practice address

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011

Phone

(503) 494-3273

NPI assigned

Mar 19, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1584576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584576000000",
    "number": "1083240295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4230 SW CHESAPEAK AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972391345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3181 SW SAM JACKSON PARK RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393011",
            "telephone_number": "503-494-3273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDER HEIDE",
        "first_name": "JESSE",
        "middle_name": "EDWARD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-03-19",
        "last_updated": "2020-03-19",
        "certification_date": "2020-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP2201X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse, Ambulatory Care",
            "state": "OR",
            "license": "200441630RN",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tara R Vandehey, CADC II/QMHP
• Emily Vandekieft
• Rebekah Elizabeth Vanden Heuvel, CSWA
• Roberta Nadine Vandentop, PHYSICIAN ASSISTANT
• Shannon Vandepas, RN
• Tessa Maurine Vander Kamp, RD, LD
• Shena Vander Ploeg
• Gretchen E Vanderbeek, MD
• Guy Vanderbeke
• Shalyn M Vanderbloemen, PA-C

• Ambulatory Care Registered Nurse in Portland, OR
• Providers in Portland, OR by specialty
• Ambulatory Care Registered Nurse in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.