Basic Information
| Provider Information | |||||||||
| NPI: | 1619013000 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CATES | ||||||||
| FirstName: | CORAL | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2120 EXCHANGE ST STE 301 | ||||||||
| Address2: | |||||||||
| City: | ASTORIA | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971033364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033250241 | ||||||||
| FaxNumber: | 5038612043 | ||||||||
| Practice Location | |||||||||
| Address1: | 2120 EXCHANGE ST STE 301 | ||||||||
| Address2: | |||||||||
| City: | ASTORIA | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971033364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033250241 | ||||||||
| FaxNumber: | 5038612043 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2007 | ||||||||
| LastUpdateDate: | 11/10/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | AP30003634 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363L00000X | AP30003634 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | MC0570069 | 01 | WA | DEA NUMBER | OTHER | 9631631 | 05 | WA | MEDICAID | 201406323CNS-PP | 01 | OR | OR LICENSE | OTHER | AP30003634 | 01 | WA | STATE LICENCE | OTHER |