Provider Demographics
NPI:1386979482
Name:HUNTWORK, COLLEEN ELIZA NASREEN (RN, FNP)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ELIZA NASREEN
Last Name:HUNTWORK
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7035 SW IVY LN APT 56
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-1163
Mailing Address - Country:US
Mailing Address - Phone:503-664-0684
Mailing Address - Fax:
Practice Address - Street 1:7035 SW IVY LN APT 56
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-1163
Practice Address - Country:US
Practice Address - Phone:503-664-0684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201709396RN163W00000X
OR15472172M00000X
OR202010084NP-PP363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse
No172M00000XOther Service ProvidersMechanotherapist
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily