MEDICARE: MS. CAROLYN RUTH NOWOSIELSKI FNP

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	363LF0000X	Family Nurse Practitioner	206650011NPFNPPP	OR

General Provider Information

NPI Number	:	1477645281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROLYN RUTH NOWOSIELSKI FNP

Provider Business Mailing Address
First Line	:	10201 SE MAIN ST STE 10
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97216-2937
Country	:	US
Telephone Number	:	503-255-2186
Fax Number	:

Provider Business Practice Location Address
First Line	:	3231 SE 59TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206
Country	:	US
Telephone Number	:	503-775-4931
Fax Number	:

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

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	06/22/2018

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