Healthcare Provider Details

I. General information

NPI: 1851078513
Provider Name (Legal Business Name): KAREN NYGREN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 CENTER ST NE
SALEM OR
97301-2669
US

IV. Provider business mailing address

2600 CENTER ST NE
SALEM OR
97301-2669
US

V. Phone/Fax

Practice location:
  • Phone: 503-947-3704
  • Fax:
Mailing address:
  • Phone: 503-947-3704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number202003935RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: