MEDICARE: MRS. KARI MICHELLE KOMLOFSKE FNP-C

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	363LF0000X	Family Nurse Practitioner	PENDING	OR

General Provider Information

NPI Number	:	1538489158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KARI MICHELLE KOMLOFSKE FNP-C

Provider Business Mailing Address
First Line	:	5684 NW SKYCREST PKWY
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97229-2329
Country	:	US
Telephone Number	:	503-645-1466
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 N GRAHAM ST STE 250
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97227-1651
Country	:	US
Telephone Number	:	503-249-0719
Fax Number	:	503-249-0749

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

Provider Enumeration Date	:	06/05/2010
Last Update Date	:	07/30/2012

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Directions to “ MRS. KARI MICHELLE KOMLOFSKE FNP-C” Practice Location

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