Provider Demographics
NPI:1457109274
Name:WARDELL, JENNIFER ALISON
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ALISON
Last Name:WARDELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E SCENIC DR STE 207
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-3447
Mailing Address - Country:US
Mailing Address - Phone:541-506-2240
Mailing Address - Fax:
Practice Address - Street 1:1011 EUGENE ST
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-1415
Practice Address - Country:US
Practice Address - Phone:541-993-6427
Practice Address - Fax:541-386-3541
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201403711RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse