Healthcare Provider Details

I. General information

NPI: 1184432833
Provider Name (Legal Business Name): KORA VANEK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2024
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 82ND DR BLDG B
GLADSTONE OR
97027-1803
US

IV. Provider business mailing address

590 E EXETER ST # A
GLADSTONE OR
97027-1706
US

V. Phone/Fax

Practice location:
  • Phone: 503-659-5515
  • Fax:
Mailing address:
  • Phone: 503-754-8048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1004118
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number201142808RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: