Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jennifer Lyn Wallace, MD

Individual provider Family Medicine Physician · NPI 1730154154

Jennifer Lyn Wallace, MD is a Family Medicine Physician in Portland, Oregon. Practices as a sole proprietor. Licensed in Oregon.

Licensed in
OR
In the registry since
2006
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1235 SE Division St Ste 208
Portland, OR 97202-1099
Phone: (888) 480-1115
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence MD24427 (OR)

Record details

NPI number1730154154
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorYes
NPI enumeratedFebruary 20, 2006
Last updated in NPPESMarch 18, 2008
Mailing address1235 Se Division St, Suite 208, Portland, OR 97202-1099

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