Basic Information
| Provider Information | |||||||||
| NPI: | 1326605734 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHARNLEY | ||||||||
| FirstName: | CORIE | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | RN, FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 36 SW NYE ST | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973653821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412654947 | ||||||||
| FaxNumber: | 8447600526 | ||||||||
| Practice Location | |||||||||
| Address1: | 1010 SW COAST HWY STE 203 | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973655215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412650445 | ||||||||
| FaxNumber: | 8447600526 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2019 | ||||||||
| LastUpdateDate: | 10/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 202007246NP-PP | OR | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 163WP0808X | 201809273RN | OR | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 363LF0000X | 202007246NP-PP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 202007246NP-PP | 01 | OR | OREGON STATE BOARD OF NURSING | OTHER | 500795963 | 05 | OR | MEDICAID | 201809273RN | 01 | OR | OREGON STATE BOARD OF NURSING | OTHER |