MEDICARE: CHARITY GRACE PAPE RN

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
1	163WH0200X	Home Health Registered Nurse	201141696RN	OR

General Provider Information

NPI Number	:	1225326002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARITY GRACE PAPE RN

Provider Business Mailing Address
First Line	:	1625 SE BIDWELL ST
Second Line	:	UNIT 7
City	:	PORTLAND
State	:	OR
Zip	:	97202-6156
Country	:	US
Telephone Number	:	541-556-5995
Fax Number	:

Provider Business Practice Location Address
First Line	:	1625 SE BIDWELL ST
Second Line	:	UNIT 7
City	:	PORTLAND
State	:	OR
Zip	:	97202-6156
Country	:	US
Telephone Number	:	541-556-5995
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2011
Last Update Date	:	07/14/2011

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