Provider Demographics
NPI:1578937835
Name:OLDS, JENNIFER (RN / BSN, MBA,)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:OLDS
Suffix:
Gender:F
Credentials:RN / BSN, MBA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 HARTFORD DR
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-2679
Mailing Address - Country:US
Mailing Address - Phone:503-706-7007
Mailing Address - Fax:
Practice Address - Street 1:1818 HARTFORD DR
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-2679
Practice Address - Country:US
Practice Address - Phone:503-706-7007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201140329RN163W00000X, 163WC0200X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice