Doctor Name: | CARLA RAYNE ANDERSON |
NPI Number: | 1144211913 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 200250170NP |
Business Practice Address: | 30250 Sw Parkway Ave Suite 7 Wilsonville, OR - 970709757 |
Business Phone Number: | 5035703366 |
Business Fax Number: | 5035703367 |
Mailing Address: | 31130 Sw Wallowa Ct, WILSONVILLE |
State: | OR |
Postal Code: | 970709778 |
Phone Number: | 5038553789 |
Fax Number: | 5035703367 |
NPI Enumeration Date: | 11/02/2005 |
NPI Last Update Date: | 11/10/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 200250170NP |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |