Healthcare Provider Details

I. General information

NPI: 1780057174
Provider Name (Legal Business Name): CORA GUREN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2015
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 NW 2ND AVE STE A
CANBY OR
97013-3517
US

IV. Provider business mailing address

7225 SW 13TH AVE
PORTLAND OR
97219-2015
US

V. Phone/Fax

Practice location:
  • Phone: 503-389-1500
  • Fax:
Mailing address:
  • Phone: 503-318-2306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number200640073RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10007532
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: