Healthcare Provider Details

I. General information

NPI: 1962584466
Provider Name (Legal Business Name): CAROLE MOST WHCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 11/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 CENTER ST NE
SALEM OR
97301-4532
US

IV. Provider business mailing address

4005 SE SALMON ST
PORTLAND OR
97214-4434
US

V. Phone/Fax

Practice location:
  • Phone: 503-588-5357
  • Fax:
Mailing address:
  • Phone: 503-239-5652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number078041864N7
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: