Unknown Individual – Pediatric Nurse Practitioner, NPI 1174647390

Unknown Individual is a healthcare provider. based in Lake oswego, Oregon. specializing in Pediatric Nurse Practitioner. They hold a License No. 000036298N2 (OR). The NPI Number for Unknown Individual is 1174647390

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1174647390
Phone
(503) 636-0943
Address
15848 SPRINGBROOK CT
Deactivation Date
17 July 2024
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 15848 SPRINGBROOK CT

    LAKE OSWEGO, OR 970343616

    Phone: (503) 636-0943

    Type: Mailing

  • 0615 SW PALATINE HILL RD

    PORTLAND, OR 972197879

    Phone: (503) 768-7165

    Fax: (503) 768-7167

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

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Medicare Enrollment & Revalidation

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No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

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No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 97034)

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Reviews

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Frequently asked questions

What NPI should I save for Unknown Individual?
Save NPI 1174647390 if you need a stable reference for Unknown Individual.
Should I trust care from Unknown Individual if status is inactive?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
Can you summarize Unknown Individual's specialty in plain language?
Clinically, the directory lists Unknown Individual with Pediatric Nurse Practitioner. Clinical services aligned with this taxonomy classification.
Does Unknown Individual practice in Oregon?
You will see Lake Oswego, Oregon on file for Unknown Individual alongside any extra practice locations.
Is this NPI for an individual or an organization?
This listing corresponds to an Individual Provider.

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