Provider Demographics
NPI:1639643943
Name:HAFEMAN, COLTON JORDON-MICHAEL (DNP, FNP-BC)
Entity type:Individual
Prefix:
First Name:COLTON
Middle Name:JORDON-MICHAEL
Last Name:HAFEMAN
Suffix:
Gender:
Credentials:DNP, FNP-BC
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 1:10215 SW HALL BLVD
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8809
Practice Address - Country:US
Practice Address - Phone:503-245-2415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-20
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202007873NP-PP363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily