Provider Demographics
NPI:1073808804
Name:RARDIN, CORI
Entity Type:Individual
Prefix:
First Name:CORI
Middle Name:
Last Name:RARDIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48799 MCFARLAND RD
Mailing Address - Street 2:
Mailing Address - City:OAKRIDGE
Mailing Address - State:OR
Mailing Address - Zip Code:97463-9632
Mailing Address - Country:US
Mailing Address - Phone:541-782-3491
Mailing Address - Fax:
Practice Address - Street 1:48799 MCFARLAND RD
Practice Address - Street 2:
Practice Address - City:OAKRIDGE
Practice Address - State:OR
Practice Address - Zip Code:97463-9632
Practice Address - Country:US
Practice Address - Phone:541-782-3491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR095000455RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse