Provider Demographics
NPI:1447685631
Name:SENIOR CARE NORTHWEST
Entity type:Organization
Organization Name:SENIOR CARE NORTHWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:503-372-6277
Mailing Address - Street 1:PO BOX 3294
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123
Mailing Address - Country:US
Mailing Address - Phone:503-327-6277
Mailing Address - Fax:503-718-7246
Practice Address - Street 1:3300 19TH AVE
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116
Practice Address - Country:US
Practice Address - Phone:503-372-6277
Practice Address - Fax:503-718-7246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-06
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201150171NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR172384Medicare UPIN