Healthcare Provider Details

I. General information

NPI: 1003560459
Provider Name (Legal Business Name): JONATHAN NOLAN HALE ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2022
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 SE MEADOWBROOK BLVD STE 2
COLLEGE PLACE WA
99324-1756
US

IV. Provider business mailing address

PO BOX 2928
PORTLAND OR
97208-2928
US

V. Phone/Fax

Practice location:
  • Phone: 888-227-3312
  • Fax: 509-529-2858
Mailing address:
  • Phone: 425-207-5155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61271241
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN60098073
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: