Provider Demographics
NPI:1174708812
Name:BEHNKE, JENNIFER SUE (APN, RN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SUE
Last Name:BEHNKE
Suffix:
Gender:F
Credentials:APN, RN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:SUE
Other - Last Name:MATZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:960 NE 28TH ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-2210
Mailing Address - Country:US
Mailing Address - Phone:503-916-9898
Mailing Address - Fax:
Practice Address - Street 1:117 NW 8TH ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-5560
Practice Address - Country:US
Practice Address - Phone:503-379-0208
Practice Address - Fax:503-662-6068
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000013155363LP0808X
OR200950051NP363LP0808X
TNRN0000157343163W00000X
OR200940952RN163W00000X
TN13155363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse