Provider Demographics
NPI:1124640842
Name:DOLAN, JADIE (ARNP)
Entity type:Individual
Prefix:
First Name:JADIE
Middle Name:
Last Name:DOLAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4858
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4858
Mailing Address - Country:US
Mailing Address - Phone:541-500-2500
Mailing Address - Fax:541-500-2700
Practice Address - Street 1:1623 N 1ST ST
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-1106
Practice Address - Country:US
Practice Address - Phone:458-300-9014
Practice Address - Fax:458-300-9015
Is Sole Proprietor?:No
Enumeration Date:2020-05-15
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61102830363LF0000X
OR202006255NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500783865Medicaid