Healthcare Provider Details

I. General information

NPI: 1700604105
Provider Name (Legal Business Name): NURSE CORWIN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

383 ATLANTIC ST
ASTORIA OR
97103-5707
US

IV. Provider business mailing address

383 ATLANTIC ST
ASTORIA OR
97103-5707
US

V. Phone/Fax

Practice location:
  • Phone: 503-717-3480
  • Fax: 503-470-2011
Mailing address:
  • Phone: 503-717-3480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: AMELIA LANDIS CORWIN
Title or Position: RN ADMINISTRATOR
Credential: RN
Phone: 503-717-3480