Individual
MS. CHRISTINE MARIE KOONCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
13007 NE GLISAN ST, PORTLAND, OR 97230-2545
(503) 215-0063
(503) 215-7864
Mailing address
3715 N LONGVIEW AVE, PORTLAND, OR 97227-1021
(503) 284-1031
(503) 215-7864
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
080045311RN
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
080045311RN
OR
Other
Enumeration date
01/24/2007
Last updated
09/28/2020
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