Healthcare Provider Details

I. General information

NPI: 1578995932
Provider Name (Legal Business Name): JENNIFER COLE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER KAY RN

II. Dates (important events)

Enumeration Date: 08/07/2013
Last Update Date: 10/15/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3270 SW PAVILION LOOP SUITE 140
PORTLAND OR
97239
US

IV. Provider business mailing address

3041 NE AINSWORTH ST
PORTLAND OR
97211-6751
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-3273
  • Fax: 503-418-2208
Mailing address:
  • Phone: 503-559-5904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number200842384RN
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60069271
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: