Provider Demographics
NPI:1003832494
Name:CAWLFIELD, JOLENE (FNP)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:
Last Name:CAWLFIELD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:559 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BURNS
Mailing Address - State:OR
Mailing Address - Zip Code:97720-1441
Mailing Address - Country:US
Mailing Address - Phone:541-573-2074
Mailing Address - Fax:541-573-8893
Practice Address - Street 1:559 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BURNS
Practice Address - State:OR
Practice Address - Zip Code:97720-1441
Practice Address - Country:US
Practice Address - Phone:541-573-2074
Practice Address - Fax:541-573-8893
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR080045993N1FNP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR276678Medicaid
ORP00158584OtherRAILROAD MEDICARE
OR838331001OtherBLUE CROSS BLUE SHIELD
OR838331001OtherBLUE CROSS BLUE SHIELD
ORR119403Medicare ID - Type Unspecified