Healthcare Provider Details

I. General information

NPI: 1619811213
Provider Name (Legal Business Name): IEVGENIIA MCKINLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15422 SW GIBRALTAR CT
BEAVERTON OR
97007-6649
US

IV. Provider business mailing address

5441 S MACADAM AVE STE N
PORTLAND OR
97239-3822
US

V. Phone/Fax

Practice location:
  • Phone: 971-708-8836
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number202100750RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: