Individual
MRS. JENNIFER HANLON-WILDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
F.N.P.
Contact information
Practice address
1810 E 19TH ST, SUITE 209, THE DALLES, OR 97058-3388
(541) 296-5657
Mailing address
PO BOX 1520, THE DALLES, OR 97058-8003
(541) 296-5657
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
098006694NP
OR
363LW0102X
Women's Health Nurse Practitioner
Primary
098006694RN FNP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
092586
—
OR
Enumeration date
11/10/2005
Last updated
02/16/2018
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