Basic Information
| Provider Information | |||||||||
| NPI: | 1588275275 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOGER | ||||||||
| FirstName: | BRENDA | ||||||||
| MiddleName: | KAY | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16865 BOONES FERRY RD | ||||||||
| Address2: | |||||||||
| City: | LAKE OSWEGO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970355280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036996464 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 16865 BOONES FERRY RD | ||||||||
| Address2: | |||||||||
| City: | LAKE OSWEGO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970355280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036996464 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2020 | ||||||||
| LastUpdateDate: | 08/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WG0000X | 201800534 | OR | N | Nursing Service Providers | Registered Nurse | General Practice | 163WG0000X | 201800534RN | OR | Y | Nursing Service Providers | Registered Nurse | General Practice |
No ID Information.