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General NPI Number Information
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NPI Number | 1316195365
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Entity Type | Organization
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Legal Business Name | CAOLI, LLC
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 11/14/2008
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Provider Practice Location Address
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Address Line | 413 MILL BEACH RD
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City | BROOKINGS
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State | OR
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Zip | 97415-9690
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Country | US
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Telephone | 541-412-8700
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Fax | 541-412-8702
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Provider Business Mailing Address
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Address Line | PO BOX 5389
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City | BROOKINGS
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State | OR
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Zip | 97415-0107
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Country | US
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Telephone | 541-412-8700
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Fax | 541-412-8702
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Authorized Official
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Title or Position | PRESIDENT
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Name | CAROL OLIVER
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Credential | NP
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Telephone | 541-412-8700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9514
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 200650010NP
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License Number State | OR
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