Organization · Type 2 NPI

Providence Portland Medical Center

Nurse Practitioner · Portland, OR

NPI number 1316199987 Active

Practice location

4805 NE Glisan St
Portland, OR 97213-2933

Mailing address

PO Box 3158
Portland, OR 97208-3158

Specialties and licenses

TaxonomyCodeLicense
Nurse Practitioner Primary 363L00000XNone listed

Nurse Practitioner: (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance wit…

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About NPI 1316199987

Providence Portland Medical Center's National Provider Identifier is 1316199987, issued on Oct 15, 2008. The primary taxonomy on file is Nurse Practitioner (363L00000X), and the practice location is in Portland, OR. The record was last updated on May 7, 2025.