MEDICARE: CAROLE L DENNISON NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	096006313N3	OR
2	363LW0102X	Women's Health Nurse Practitioner	096006313N7	OR
3	363LA2200X	Adult Health Nurse Practitioner	096006313N3	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245211374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLE L DENNISON NP

Provider Business Mailing Address
First Line	:	7650 SW BEVELAND RD
Second Line	:	SUITE 200
City	:	PORTLAND
State	:	OR
Zip	:	97223-8692
Country	:	US
Telephone Number	:	503-855-1620
Fax Number	:	503-840-3299

Provider Business Practice Location Address
First Line	:	19250 SW 65TH AVE
Second Line	:	SUITE 325
City	:	TUALATIN
State	:	OR
Zip	:	97062-7452
Country	:	US
Telephone Number	:	503-692-1242
Fax Number	:	503-691-3615

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	10/08/2018

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Directions to “ CAROLE L DENNISON NP” Practice Location

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