Healthcare Provider Details

I. General information

NPI: 1700190030
Provider Name (Legal Business Name): MISHA RAE CALDWELL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2010
Last Update Date: 11/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2158 EXCHANGE ST. SUITE #206/207
ASTORIA OR
97103
US

IV. Provider business mailing address

2158 EXCHANGE ST. SUITE #206/207
ASTORIA OR
97103
US

V. Phone/Fax

Practice location:
  • Phone: 503-325-7337
  • Fax: 503-325-3706
Mailing address:
  • Phone: 503-325-7337
  • Fax: 503-325-3706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP9191206
License Number StateFL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1700190030
Identifier TypeMEDICAID
Identifier StateFL
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: