Provider Demographics
NPI:1548029382
Name:MCCORMICK, KRISTEN MARIE (RN)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARIE
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5825 NE RAY CIR
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-6436
Mailing Address - Country:US
Mailing Address - Phone:503-614-1428
Mailing Address - Fax:
Practice Address - Street 1:5825 NE RAY CIR
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-6436
Practice Address - Country:US
Practice Address - Phone:503-614-1428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201390242RN163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool