Healthcare Provider Details

I. General information

NPI: 1912555988
Provider Name (Legal Business Name): CARLA ANN WARREN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date: 10/31/2024
Reactivation Date: 11/11/2024

III. Provider practice location address

883 NW GRANT AVE
CORVALLIS OR
97330-4539
US

IV. Provider business mailing address

PO BOX 16308
PORTLAND OR
97292-0308
US

V. Phone/Fax

Practice location:
  • Phone: 541-320-9555
  • Fax: 541-316-7329
Mailing address:
  • Phone: 503-255-2343
  • Fax: 503-255-2344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10032272
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: