Healthcare Provider Details

I. General information

NPI: 1376313205
Provider Name (Legal Business Name): KATE OPPEGAARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

599 S LIESER RD
VANCOUVER WA
98664-2215
US

IV. Provider business mailing address

599 S LIESER RD
VANCOUVER WA
98664-2215
US

V. Phone/Fax

Practice location:
  • Phone: 415-867-1363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number10013566
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: