Healthcare Provider Details

I. General information

NPI: 1780662296
Provider Name (Legal Business Name): CORLYN MARIE CASPERS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 06/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8495 CRATER LAKE HWY VA SOUTHERN OREGON
WHITE CITY OR
97503-3011
US

IV. Provider business mailing address

8495 CRATER LAKE HWY VA SOUTHERN OREGON
WHITE CITY OR
97503-3011
US

V. Phone/Fax

Practice location:
  • Phone: 541-826-2111
  • Fax: 541-830-7550
Mailing address:
  • Phone: 541-826-2111
  • Fax: 541-830-7550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number086000066N3
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number086000066N3ANP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: