Healthcare Provider Details

I. General information

NPI: 1164536546
Provider Name (Legal Business Name): KAREN MARIE COOK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 04/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73265 CONFEDERATED WAY
PENDLETON OR
97801-0160
US

IV. Provider business mailing address

73265 CONFEDERATED WAY
PENDLETON OR
97801-0160
US

V. Phone/Fax

Practice location:
  • Phone: 541-215-1965
  • Fax: 541-278-7572
Mailing address:
  • Phone: 541-215-1965
  • Fax: 541-278-7572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR43012
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: