Healthcare Provider Details

I. General information

NPI: 1215046172
Provider Name (Legal Business Name): KAROLINE WOITKE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 11/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 8TH AVE STE 100
WEST LINN OR
97068
US

IV. Provider business mailing address

PO BOX 6689
PORTLAND OR
97228-6689
US

V. Phone/Fax

Practice location:
  • Phone: 503-655-3320
  • Fax: 503-655-3321
Mailing address:
  • Phone: 503-413-3900
  • Fax: 503-413-3710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA00647
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00647
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: