MEDICARE: KARIN KALLEVIG

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	163WC0400X	Case Management Registered Nurse	200341984RN	OR

General Provider Information

NPI Number	:	1487410833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARIN KALLEVIG

Provider Business Mailing Address
First Line	:	38505 BROOTEN RD STE A
Second Line	:
City	:	PACIFIC CITY
State	:	OR
Zip	:	97135-8049
Country	:	US
Telephone Number	:	503-815-7562
Fax Number	:

Provider Business Practice Location Address
First Line	:	38505 BROOTEN RD STE A
Second Line	:
City	:	PACIFIC CITY
State	:	OR
Zip	:	97135-8049
Country	:	US
Telephone Number	:	503-815-7562
Fax Number	:

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

Provider Enumeration Date	:	02/23/2024
Last Update Date	:	02/23/2024

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