Provider Demographics
NPI:1871602136
Name:PITTENGER, CAROLYN KAY (RN)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:KAY
Last Name:PITTENGER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12601 SE REGENCY VIEW ST
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-7359
Mailing Address - Country:US
Mailing Address - Phone:503-698-6262
Mailing Address - Fax:503-698-7412
Practice Address - Street 1:690 BARNES BLVD
Practice Address - Street 2:62ND MDG
Practice Address - City:MCCHORD AFB
Practice Address - State:WA
Practice Address - Zip Code:98438-1303
Practice Address - Country:US
Practice Address - Phone:253-982-9917
Practice Address - Fax:253-982-8406
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23210163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse