Provider Demographics
NPI:1053478792
Name:DAMOS, CAROLYN DIANE (RN)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:DIANE
Last Name:DAMOS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 65TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-7068
Mailing Address - Country:US
Mailing Address - Phone:541-746-2362
Mailing Address - Fax:541-736-4974
Practice Address - Street 1:431 65TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97478-7068
Practice Address - Country:US
Practice Address - Phone:541-746-2362
Practice Address - Fax:541-736-4974
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse