Provider Demographics
NPI:1386644011
Name:FOLK, CATHLEEN A (FNP)
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:A
Last Name:FOLK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 SW VERMONT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-1940
Mailing Address - Country:US
Mailing Address - Phone:503-452-0915
Mailing Address - Fax:503-768-9232
Practice Address - Street 1:2400 SW VERMONT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-1940
Practice Address - Country:US
Practice Address - Phone:503-452-0915
Practice Address - Fax:503-768-9232
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR089006368N1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR002670Medicaid
OR002670Medicaid
S49219Medicare UPIN