Individual
CARYL LOUISE KENWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.N., F.N.P.
Contact information
Practice address
4805 NE GLISAN ST, PORTLAND, OR 97213-2933
(503) 297-6334
(503) 297-2360
Mailing address
9340 SW BARNES RD, SUITE 202, PORTLAND, OR 97225-6623
(503) 297-6334
(503) 297-2360
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
093006097N1-FNP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114970
—
OR
Enumeration date
08/13/2006
Last updated
08/25/2014
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