| Providence Health & Services - Oregon | |
|
4400 Ne Halsey Bldg 2 3rd Flr Portalnd OR 97213 | |
| (855) 229-6460 | |
| (503) 216-0710 |
| Full Name | Providence Health & Services - Oregon |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 4400 Ne Halsey, Portalnd, Oregon |
| Authorized Official Name and Position | Donald Wayne Anderson (ASSISTANT SECRETARY ENROLLMENT) |
| Authorized Official Contact | 4253589786 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Health & Services - Oregon Po Box 3158 Portland OR 97208-3158 Ph: () - | Providence Health & Services - Oregon 4400 Ne Halsey Bldg 2 3rd Flr Portalnd OR 97213 Ph: (855) 229-6460 |
| NPI Number | 1790113405 |
|---|---|
| Provider Enumeration Date | 10/16/2013 |
| Last Update Date | 03/25/2026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790113405 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Primary |