Provider Demographics
NPI:1952068017
Name:CROSLAND, JESSE TYLER (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JESSE
Middle Name:TYLER
Last Name:CROSLAND
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 1:9743 SE WESSEX WAY
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-7034
Mailing Address - Country:US
Mailing Address - Phone:619-990-8518
Mailing Address - Fax:
Practice Address - Street 1:9743 SE WESSEX WAY
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-7034
Practice Address - Country:US
Practice Address - Phone:619-990-8519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201240286RN163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR23565982OtherKAISER PERMANENTE