Provider Demographics
NPI:1639643943
Name:HAFEMAN, COLTON JORDON-MICHAEL (FNP)
Entity Type:Individual
Prefix:DR
First Name:COLTON
Middle Name:JORDON-MICHAEL
Last Name:HAFEMAN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12388 NW ASHTON DR
Mailing Address - Street 2:
Mailing Address - City:BANKS
Mailing Address - State:OR
Mailing Address - Zip Code:97106-6051
Mailing Address - Country:US
Mailing Address - Phone:503-313-9187
Mailing Address - Fax:
Practice Address - Street 1:444 FORT ST
Practice Address - Street 2:FL 2
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4535
Practice Address - Country:US
Practice Address - Phone:208-422-1018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-20
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201704302RN163WP0808X
OR202007873NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health