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Contact Information

PROVIDENCE HEALTH & SERVICES - OREGON
4805 NE GLISAN ST
STE 6N50
PORTLAND, OR97213-2933
 Phone: 503-215-1351
 Fax: 503-215-1349
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Medical Oncology

207RX0202X 11 Physician/Internal Medicine
 

Clinic/Center

261Q00000X
 

Nurse Practitioner

363L00000X 50 Nurse Practitioner
Indicates primary specialty

NPI Profile & details for PROVIDENCE HEALTH SERVICES OREGON · (Female)

NPI # 1801193339
Status Active
Credentials
Entity Individual
Enumeration date 02/18/2011
Last updated 07/04/2025 - About 11 months ago
Sole proprietor 1 Not specified
Identifiers
  • OR Medicaid 500633960
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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