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NPI Code Detail

MEDICARE: MS. CHRISTINE MARIE KOONCE PMHNP

MEDICARE: MS. CHRISTINE MARIE KOONCE PMHNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WP0808XPsychiatric/Mental Health Registered Nurse080045311RNOR
2363LP0808XPsychiatric/Mental Health Nurse Practitioner080045311RNOR

General Provider Information

NPI Number : 1134274400
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CHRISTINE MARIE KOONCE PMHNP
Provider Business Mailing Address
First Line : 3715 N LONGVIEW AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97227-1021
Country : US
Telephone Number : 503-284-1031
Fax Number : 503-215-7864
Provider Business Practice Location Address
First Line : 13007 NE GLISAN ST
Second Line :
City : PORTLAND
State : OR
Zip : 97230-2545
Country : US
Telephone Number : 503-215-0063
Fax Number : 503-215-7864
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2007
Last Update Date : 09/28/2020

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