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General NPI Number Information
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NPI Number | 1134274400
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Entity Type | Individual
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Provider Name | CHRISTINE MARIE KOONCE PMHNP
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Gender | Female
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 09/28/2020
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Provider Practice Location Address
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Address Line | 13007 NE GLISAN ST
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City | PORTLAND
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State | OR
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Zip | 97230-2545
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Country | US
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Telephone | 503-215-0063
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Fax | 503-215-7864
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Provider Business Mailing Address
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Address Line | 3715 N LONGVIEW AVE
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City | PORTLAND
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State | OR
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Zip | 97227-1021
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Country | US
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Telephone | 503-284-1031
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Fax | 503-215-7864
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 080045311RN
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 080045311RN
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License Number State | OR
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