Provider Demographics
NPI:1487216669
Name:CAROLYN D CONCIA NP PROF CORP
Entity Type:Organization
Organization Name:CAROLYN D CONCIA NP PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CONCIA
Authorized Official - Suffix:
Authorized Official - Credentials:GNP
Authorized Official - Phone:971-294-0560
Mailing Address - Street 1:2308 NW STIMPSON LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-8562
Mailing Address - Country:US
Mailing Address - Phone:971-294-0560
Mailing Address - Fax:
Practice Address - Street 1:2308 NW STIMPSON LN
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-8562
Practice Address - Country:US
Practice Address - Phone:971-294-0560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty