Individual
JACQUELINE J COLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
5228 NE HOYT ST STE 300, PORTLAND, OR 97213-3055
(530) 215-4860
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
201803764NP-PP
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
95003585
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500748015
—
OR
Enumeration date
12/29/2015
Last updated
04/04/2019
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