Provider Demographics
NPI:1699093450
Name:DOUGLAS, CARMA JB (AGNP-BC, CLT-LANA)
Entity type:Individual
Prefix:
First Name:CARMA
Middle Name:JB
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:AGNP-BC, CLT-LANA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 E 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-4362
Mailing Address - Country:US
Mailing Address - Phone:541-554-2825
Mailing Address - Fax:
Practice Address - Street 1:1355 OAK ST STE 100
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3566
Practice Address - Country:US
Practice Address - Phone:541-683-1125
Practice Address - Fax:541-683-2049
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-04
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR089003081RN163W00000X
OR7641225700000X
OR201901675NP-PP363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist