Healthcare Provider Details

I. General information

NPI: 1952212805
Provider Name (Legal Business Name): JENNIE L COLBRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W LOCUST ST
STANFIELD OR
97875-9704
US

IV. Provider business mailing address

1720 KAY ST NE
SALEM OR
97301-2245
US

V. Phone/Fax

Practice location:
  • Phone: 541-371-8568
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number10035212
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: