| Doctor Name: | JACQUELYN ROSE QUETAL |
| NPI Number: | 1003061292 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 1368 |
| Business Practice Address: | 12710 Se Division St Portland, OR - 972363134 |
| Business Phone Number: | 5039883663 |
| Business Fax Number: | 5039883015 |
| Mailing Address: | 421 Sw Oak St, Ste.210 PORTLAND |
| State: | OR |
| Postal Code: | 972041817 |
| Phone Number: | 5039883663 |
| Fax Number: | 5039883015 |
| NPI Enumeration Date: | 12/01/2008 |
| NPI Last Update Date: | 03/07/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 1368 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | HI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |