Healthcare Provider Details

I. General information

NPI: 1013299775
Provider Name (Legal Business Name): MERIKA DOLIN GOLDSTEIN FNP, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2011
Last Update Date: 12/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 N ADAIR ST
CORNELIUS OR
97113-8900
US

IV. Provider business mailing address

1151 N ADAIR ST
CORNELIUS OR
97113-8900
US

V. Phone/Fax

Practice location:
  • Phone: 503-359-5564
  • Fax:
Mailing address:
  • Phone: 503-359-5564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number615565
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number336772
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201407083NP-PP
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201407082RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: