Healthcare Provider Details

I. General information

NPI: 1447508833
Provider Name (Legal Business Name): COLEEN M CARNEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11850 SW GREENBURG RD
PORTLAND OR
97223-6451
US

IV. Provider business mailing address

11850 SW GREENBURG RD
PORTLAND OR
97223-6451
US

V. Phone/Fax

Practice location:
  • Phone: 503-680-2355
  • Fax:
Mailing address:
  • Phone: 503-680-2355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number081940741RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: