Provider Demographics
NPI:1912142746
Name:NASH, CORAL A (ARNP)
Entity Type:Individual
Prefix:
First Name:CORAL
Middle Name:A
Last Name:NASH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CENTERPOINTE DR
Mailing Address - Street 2:STE 200
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-8653
Mailing Address - Country:US
Mailing Address - Phone:503-797-2268
Mailing Address - Fax:503-234-8227
Practice Address - Street 1:13200 SW PACIFIC HWY
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-4828
Practice Address - Country:US
Practice Address - Phone:503-598-2000
Practice Address - Fax:503-639-0920
Is Sole Proprietor?:No
Enumeration Date:2008-12-08
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201150005363LA2200X, 363LF0000X
WAAP60060145363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR8879054Medicare UPIN