Healthcare Provider Details

I. General information

NPI: 1801467261
Provider Name (Legal Business Name): JODIE ANNE HALL AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 OAK ST SE STE 4030
SALEM OR
97301-3984
US

IV. Provider business mailing address

875 OAK ST SE STE 4030
SALEM OR
97301-3984
US

V. Phone/Fax

Practice location:
  • Phone: 503-561-6444
  • Fax: 503-561-6440
Mailing address:
  • Phone: 503-561-6444
  • Fax: 503-561-6440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number202010835NP-PP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberN261191889
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: