Provider Demographics
NPI:1003560459
Name:HALE, JONATHAN NOLAN (ARNP)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:NOLAN
Last Name:HALE
Suffix:
Gender:M
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 2928
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-2928
Mailing Address - Country:US
Mailing Address - Phone:425-207-5155
Mailing Address - Fax:
Practice Address - Street 1:1705 SE MEADOWBROOK BLVD STE 2
Practice Address - Street 2:
Practice Address - City:COLLEGE PLACE
Practice Address - State:WA
Practice Address - Zip Code:99324-1756
Practice Address - Country:US
Practice Address - Phone:888-227-3312
Practice Address - Fax:509-529-2858
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61271241363LF0000X
WARN60098073363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP61271241OtherDOH LICENSE
WARN60098073OtherDOH LICENSE