Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 098006694NP | OR |
Y | 363LW0102X | Nurse Practitioner - Women's Health | 098006694RN FNP-PP | OR |
NPI | 1033190574 |
---|---|
Provider Name | Mrs. Jennifer Hanlon-Wilde |
First Address | The Dalles, OR 97058-8003 |
Second Address | The Dalles, OR 97058-3388 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2005 |
Last Update Date | 16/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
092586 | (05) | OR |
S61875 | (02) |