Active NPI
Connie Louise Jaeger, RN, WHCNP
- Women's Health Nurse Practitioner
- Dallas, OR
National Provider Identifier
1487876561
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Women's Health Nurse Practitioner
- License
- 000031638N7
- Practice address
- 182 SW Academy St
Ste 302
Dallas, OR 97338-1922 - Phone
- (503) 623-8175
- Fax
- (503) 831-3499
- NPI assigned
- May 2, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Women's Health Nurse Practitioner | 363LW0102X | 000031638N7 | OR | Primary |
Addresses
Primary practice location
182 SW Academy St
Ste 302
Dallas, OR 97338-1922
Mailing address
2101 Perrydale Rd
Dallas, OR 97338-9359
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000031638N7 | OR | MD | Women's Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1487876561",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2101 PERRYDALE RD",
"city": "DALLAS",
"state": "OR",
"postal_code": "973389359"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "182 SW ACADEMY ST",
"address_2": "STE 302",
"city": "DALLAS",
"state": "OR",
"postal_code": "973381922",
"telephone_number": "503-623-8175",
"fax_number": "503-831-3499"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JAEGER",
"first_name": "CONNIE",
"middle_name": "LOUISE",
"credential": "RN, WHCNP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LW0102X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Women's Health",
"state": "OR",
"license": "000031638N7",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.