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NPI Code Detail

MEDICARE: GLENDA M WATSON-COLY RN

MEDICARE: GLENDA M WATSON-COLY 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
1163W00000XRegistered Nurse201902896RNOR

General Provider Information

NPI Number : 1730146465
Entity Type Code : Individual
Provider Name (Legal Business Name) : GLENDA M WATSON-COLY RN
Provider Business Mailing Address
First Line : 1776 SW MADISON ST
Second Line :
City : PORTLAND
State : OR
Zip : 97205-1715
Country : US
Telephone Number : 503-224-1044
Fax Number : 503-621-2235
Provider Business Practice Location Address
First Line : 12360 E BURNSIDE ST
Second Line :
City : PORTLAND
State : OR
Zip : 97233-1042
Country : US
Telephone Number : 971-279-4800
Fax Number : 971-279-2051
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2006
Last Update Date : 10/05/2021

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