Individual
MS. CAROLYN DOLORES CONCIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2308 NW STIMPSON LN, PORTLAND, OR 97229-8562
(919) 561-0140
Mailing address
2308 NW STIMPSON LN, PORTLAND, OR 97229-8562
(919) 561-0140
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
099007642N4
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
067593012
BLUE CROSS BLUE SHIELD
OR
05
—
289362
—
OR
Enumeration date
05/30/2006
Last updated
02/19/2016
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