Healthcare Provider Details

I. General information

NPI: 1588668933
Provider Name (Legal Business Name): KAREN A. KIRWAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 MOUNTAIN VIEW LN SUITE 200
FOREST GROVE OR
97116-2893
US

IV. Provider business mailing address

PO BOX 189
FOREST GROVE OR
97116-0189
US

V. Phone/Fax

Practice location:
  • Phone: 503-359-4773
  • Fax: 503-359-3809
Mailing address:
  • Phone: 503-359-4773
  • Fax: 503-359-3809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number091006149N1
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: