Healthcare Provider Details

I. General information

NPI: 1528918679
Provider Name (Legal Business Name): MRS. CARA MARLENE NYBORG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2327 SW 4TH AVE STE 1
ONTARIO OR
97914-1851
US

IV. Provider business mailing address

2327 SW 4TH AVE
ONTARIO OR
97914-1851
US

V. Phone/Fax

Practice location:
  • Phone: 541-889-2340
  • Fax:
Mailing address:
  • Phone: 541-889-2340
  • Fax: 541-889-2997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number10059862
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: