Provider Demographics
NPI:1326605734
Name:CHARNLEY, CORIE MICHELLE (RN, FNP-C)
Entity Type:Individual
Prefix:
First Name:CORIE
Middle Name:MICHELLE
Last Name:CHARNLEY
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 SW NYE ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-3821
Mailing Address - Country:US
Mailing Address - Phone:541-265-4947
Mailing Address - Fax:844-760-0526
Practice Address - Street 1:1010 SW COAST HWY STE 203
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-5215
Practice Address - Country:US
Practice Address - Phone:541-265-0445
Practice Address - Fax:844-760-0526
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202007246NP-PP363L00000X, 363LF0000X
OR201809273RN163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR202007246NP-PPOtherOREGON STATE BOARD OF NURSING
OR500795963Medicaid
OR201809273RNOtherOREGON STATE BOARD OF NURSING