Basic Information
Provider Information
NPI: 1144516253
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CALCAGNO
FirstName: CHERYL
MiddleName: ANN
NamePrefix: MS.
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2051 KAEN RD STE 367
Address2:  
City: OREGON CITY
State: OR
PostalCode: 970454035
CountryCode: US
TelephoneNumber: 5037425300
FaxNumber: 5037425979
Practice Location
Address1: 9775 SE SUNNYSIDE RD STE 200
Address2:  
City: CLACKAMAS
State: OR
PostalCode: 970155721
CountryCode: US
TelephoneNumber: 5036558471
FaxNumber: 5037234907
Other Information
ProviderEnumerationDate: 06/27/2011
LastUpdateDate: 10/18/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X079043337N1ORY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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