Provider Demographics
NPI:1639820236
Name:MCCOWN, FRANCINE FONKOU
Entity Type:Individual
Prefix:
First Name:FRANCINE
Middle Name:FONKOU
Last Name:MCCOWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FRANCINE
Other - Middle Name:FONKOU
Other - Last Name:TALLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4597 SE BROOKSIDE DR APT 24
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-4144
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:822 NE 162ND AVE BUILDING F
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230
Practice Address - Country:US
Practice Address - Phone:503-255-4205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202102469RN163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent