Provider Demographics
NPI:1285284901
Name:SMITH COLE, JENGER
Entity type:Individual
Prefix:MRS
First Name:JENGER
Middle Name:
Last Name:SMITH COLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 DIVISION ST UNIT 327
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-5402
Mailing Address - Country:US
Mailing Address - Phone:541-965-1531
Mailing Address - Fax:
Practice Address - Street 1:4739 CHENOWETH RD
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-4521
Practice Address - Country:US
Practice Address - Phone:541-965-1531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-14
Last Update Date:2019-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider