Provider Demographics
NPI:1639221609
Name:MOLINE, ELIZABETH COLBERT (NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:COLBERT
Last Name:MOLINE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 NW THOMSEN LN
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-2831
Mailing Address - Country:US
Mailing Address - Phone:503-472-1016
Mailing Address - Fax:
Practice Address - Street 1:2700 SE STRATUS AVE
Practice Address - Street 2:WILLAMETTE VALLEY MEDICAL CENTER, OCCUPATIONAL MEDICINE
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-8872
Practice Address - Country:US
Practice Address - Phone:503-435-6556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA375372363L00000X
IN71000684A363L00000X
OR200950008NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner