Active NPI
Jennifer Ann Brokaw, RN
- Registered Nurse
- Portland, OR
National Provider Identifier
1699555870
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 200441312RN
- Practice address
- 4805 NE Glisan St
Portland, OR 97213-2933 - Phone
- (503) 215-6190
- NPI assigned
- Oct 4, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 200441312RN | OR | Primary |
Addresses
Primary practice location
4805 NE Glisan St
Portland, OR 97213-2933
Mailing address
4917 Parkview Dr Apt a
Lake Oswego, OR 97035-4474
Phone (150) 372-6674
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 200441312RN | OR | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1696377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1696377600000",
"number": "1699555870",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4917 PARKVIEW DR APT A",
"city": "LAKE OSWEGO",
"state": "OR",
"postal_code": "970354474",
"telephone_number": "150-372-6674"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4805 NE GLISAN ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972132933",
"telephone_number": "503-215-6190"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROKAW",
"first_name": "JENNIFER",
"middle_name": "ANN",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-10-04",
"last_updated": "2023-10-04",
"certification_date": "2023-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "OR",
"license": "200441312RN",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.