Healthcare Provider Details

I. General information

NPI: 1417813585
Provider Name (Legal Business Name): JENNIFER LEE NYGAARD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2026
Last Update Date: 01/01/2026
Certification Date: 01/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2265 EXCHANGE ST
ASTORIA OR
97103-3331
US

IV. Provider business mailing address

2265 EXCHANGE ST
ASTORIA OR
97103-3331
US

V. Phone/Fax

Practice location:
  • Phone: 503-338-4075
  • Fax: 503-338-4076
Mailing address:
  • Phone: 503-338-4075
  • Fax: 503-338-4076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number200642708RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: