Provider Demographics
NPI:1972519429
Name:O'BOYLE-JORDAN, BRIDGET THERESA (CPNP)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:THERESA
Last Name:O'BOYLE-JORDAN
Suffix:
Gender:F
Credentials:CPNP
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 574
Mailing Address - Street 2:MAIL CODE CDRC
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97207-0574
Mailing Address - Country:US
Mailing Address - Phone:503-494-0429
Mailing Address - Fax:503-494-4447
Practice Address - Street 1:21900 WILLAMETTE DR STE 202
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-3284
Practice Address - Country:US
Practice Address - Phone:503-653-0631
Practice Address - Fax:503-653-1464
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200541965RN363LP0200X
OR200550154NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR023299Medicaid
OR023299Medicaid