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NPI Code Detail

MEDICARE: JENNIFER OLDS RN / BSN, MBA,

MEDICARE: JENNIFER OLDS RN / BSN, MBA,
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
1163W00000XRegistered Nurse201140329RNOR
2163WC0200XCritical Care Medicine Registered Nurse201140329RNOR
3163WG0000XGeneral Practice Registered Nurse201140329RNOR

General Provider Information

NPI Number : 1578937835
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER OLDS RN / BSN, MBA,
Provider Business Mailing Address
First Line : 1818 HARTFORD DR
Second Line :
City : FOREST GROVE
State : OR
Zip : 97116-2679
Country : US
Telephone Number : 503-706-7007
Fax Number :
Provider Business Practice Location Address
First Line : 1818 HARTFORD DR
Second Line :
City : FOREST GROVE
State : OR
Zip : 97116-2679
Country : US
Telephone Number : 503-706-7007
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/23/2015
Last Update Date : 11/23/2015

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