Provider Demographics
NPI:1871688689
Name:MCCAHON, CAROL DILLON (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:DILLON
Last Name:MCCAHON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:CAROL
Other - Middle Name:J
Other - Last Name:DILLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 3360
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3360
Mailing Address - Country:US
Mailing Address - Phone:866-366-2983
Mailing Address - Fax:
Practice Address - Street 1:930 N. BROADWAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201
Practice Address - Country:US
Practice Address - Phone:425-317-0310
Practice Address - Fax:425-317-0303
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08472363LF0000X
WAAP60107871363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0255279Medicaid
OH2633270Medicaid
WA0255279Medicaid
WAG8886204Medicare PIN