Unknown Individual – Pediatric Nurse Practitioner, NPI 1174647390
Pediatric Nurse Practitioner
Main info
Profile Insights
NPPES metrics only — not quality of care.
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)
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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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