Healthcare Provider Details

I. General information

NPI: 1811235278
Provider Name (Legal Business Name): KATHERINE COLVIN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2013
Last Update Date: 01/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2368 WESTMINSTER AVE NW
SALEM OR
97304-1809
US

IV. Provider business mailing address

2368 WESTMINSTER AVE NW
SALEM OR
97304-1809
US

V. Phone/Fax

Practice location:
  • Phone: 971-241-5087
  • Fax:
Mailing address:
  • Phone: 971-241-5087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number200940007RN
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number200940007RN
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number200940007RN
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number200940007RN
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number200940007RN
License Number StateOR
# 6
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number200940007RN
License Number StateOR
# 7
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number200940007RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: