Healthcare Provider Details

I. General information

NPI: 1205744547
Provider Name (Legal Business Name): COLLEEN ELIZABETH CONNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2608 CASCADIA INDUSTRIAL ST SE
SALEM OR
97302-1372
US

IV. Provider business mailing address

1134 SWINGWOOD CT NE
KEIZER OR
97303-3503
US

V. Phone/Fax

Practice location:
  • Phone: 503-371-4567
  • Fax:
Mailing address:
  • Phone: 503-856-6117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number202110538RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: