MEDICARE: JOLENE CAWLFIELD FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	080045993N1FNP-PP	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00158584	OTHER	OR	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	838331001	OTHER	OR	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1003832494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOLENE CAWLFIELD FNP

Provider Business Mailing Address
First Line	:	559 W WASHINGTON ST
Second Line	:
City	:	BURNS
State	:	OR
Zip	:	97720-1441
Country	:	US
Telephone Number	:	541-573-2074
Fax Number	:	541-573-8893

Provider Business Practice Location Address
First Line	:	559 W WASHINGTON ST
Second Line	:
City	:	BURNS
State	:	OR
Zip	:	97720-1441
Country	:	US
Telephone Number	:	541-573-2074
Fax Number	:	541-573-8893

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	07/22/2008

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