Basic Information
| Provider Information | |||||||||
| NPI: | 1245612696 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JANINI | ||||||||
| FirstName: | COLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1175 MOUNT HOOD AVE | ||||||||
| Address2: | |||||||||
| City: | WOODBURN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970719060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039822000 | ||||||||
| FaxNumber: | 5039820660 | ||||||||
| Practice Location | |||||||||
| Address1: | 1175 MOUNT HOOD AVE | ||||||||
| Address2: | |||||||||
| City: | WOODBURN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970719060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039822000 | ||||||||
| FaxNumber: | 5039820660 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2015 | ||||||||
| LastUpdateDate: | 03/18/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | PA172334 | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.