Jean Oldham
Individual provider Active NPI Registered Nurse · Phoenix, OR
NPI 1124844428 · NPPES record last updated Dec 2, 2024
Key facts
- NPI
- 1124844428
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 200942872RN (OR)
- Practice address
- 745 N Rose St
Phoenix, OR 97535-5704 - Phone
- (541) 535-6239
- NPI assigned
- Dec 2, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 200942872RN | OR | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| La Clinica del Valle Family Health Care Center Inc. | Current |
Accepting new patients | |
| La Clinica del Valle Family Health Care Center Inc. | Past | Accepting new patients | |
| La Clinica del Valle Family Health Care Center Inc. | Past |
Accepting new patients |
Locations
931 Chevy Way
Medford, OR 97504
Phone (541) 690-3555
745 N Rose St
Phoenix, OR 97535
Phone (541) 535-1526
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 200942872RN | OR | Yes |
Addresses
Primary practice location
745 N Rose St
Phoenix, OR 97535-5704
Mailing address
931 Chevy Way
Medford, OR 97504-4127
Other practice location 1
2838 W Main St
Medford, OR 97501-2405
Phone (541) 535-6239
Other providers in Phoenix, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 2, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.