Individual
KARSON FISHER NASSTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1900 WOODLAND DR, COOS BAY, OR 97420-0000
(541) 267-5151
(541) 266-4501
Mailing address
1900 WOODLAND DR, COOS BAY, OR 97420-0000
(541) 267-5151
(541) 266-4501
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
200550009NP-PP
OR
363LF0000X
Family Nurse Practitioner
200550009NP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022957
—
OR
01
—
1407812365
NBMC GROUP NPI NUMBER
OR
01
—
930635514
GROUP TAX ID FOR BILLING
OR
01
—
R0000WFBTV
MEDICARE GROUP PIN NUMBER
OR
Enumeration date
05/18/2006
Last updated
03/23/2010
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