Provider Demographics
NPI:1609670306
Name:SUM SIQUINA, JESSICA ALEXANDRA (NP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ALEXANDRA
Last Name:SUM SIQUINA
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8745 SUNNYVIEW RD NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-9549
Mailing Address - Country:US
Mailing Address - Phone:503-830-8707
Mailing Address - Fax:
Practice Address - Street 1:1585 N PACIFIC HWY STE E
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-3665
Practice Address - Country:US
Practice Address - Phone:503-510-8135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10042713261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care