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1912555988 NPI number — CARLA ANN WARREN APRN

NPI Number: 1912555988
Health Care Provider/Practitioner: CARLA ANN WARREN APRN

Information about “1912555988” NPI (CARLA ANN WARREN APRN) exists in 1912555988 in HTML format HTML  |  1912555988 in plain Text format TXT  |  1912555988 in PDF (Portable Document Format) PDF  |  1912555988 in an XML format XML  formats.

NPI Number : 1912555988 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1912555988",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WARREN",
    "FirstName": "CARLA",
    "MiddleName": "ANN",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "APRN",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 16308",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PORTLAND",
    "MailingAddressStateName": "OR",
    "MailingAddressPostalCode": "97292-0308",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "503-255-2343",
    "MailingAddressFaxNumber": "503-255-2344",
    "FirstLinePracticeLocationAddress": "883 NW GRANT AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CORVALLIS",
    "PracticeLocationAddressStateName": "OR",
    "PracticeLocationAddressPostalCode": "97330-4539",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "541-320-9555",
    "PracticeLocationAddressFaxNumber": "541-316-7329",
    "EnumerationDate": "09/03/2019",
    "LastUpdateDate": "11/27/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "10/31/2024",
    "NPIReactivationDate": "11/11/2024",
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LP0808X",
        "TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
        "LicenseNumber": "10032272",
        "LicenseNumberStateCode": "OR",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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