Provider Demographics
NPI:1477078491
Name:KAPULER, PREMA KUSRA (QMHA)
Entity Type:Individual
Prefix:
First Name:PREMA
Middle Name:KUSRA
Last Name:KAPULER
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:MS
Other - First Name:KUSRA
Other - Middle Name:
Other - Last Name:KAPULER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1650 SW 45TH PL
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-1768
Mailing Address - Country:US
Mailing Address - Phone:541-757-8068
Mailing Address - Fax:
Practice Address - Street 1:1650 SW 45TH PL
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-1768
Practice Address - Country:US
Practice Address - Phone:541-757-8068
Practice Address - Fax:541-758-1030
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-10
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator