Provider Demographics
NPI:1225284847
Name:KOULOURIS-MCCARVER, MADELINE KATHERINE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MADELINE
Middle Name:KATHERINE
Last Name:KOULOURIS-MCCARVER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:MADELINE
Other - Middle Name:KATHERINE
Other - Last Name:MCCARVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8316 SE RHONE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-2931
Mailing Address - Country:US
Mailing Address - Phone:503-415-0330
Mailing Address - Fax:
Practice Address - Street 1:8316 SE RHONE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-2931
Practice Address - Country:US
Practice Address - Phone:503-415-0330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200841829RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse