Provider Demographics
NPI:1508113408
Name:OLTMAN, JESSICA L (FNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:OLTMAN
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 1:600 NW 11TH ST
Mailing Address - Street 2:SUITE E-15
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-8605
Mailing Address - Country:US
Mailing Address - Phone:541-567-6434
Mailing Address - Fax:541-429-6613
Practice Address - Street 1:600 NW 11TH ST
Practice Address - Street 2:SUITE E-15
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-8605
Practice Address - Country:US
Practice Address - Phone:541-567-6434
Practice Address - Fax:541-429-6613
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO204271163W00000X
CO0990427-NP363LF0000X
OR201401076NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO19588828Medicaid