Healthcare Provider Details

I. General information

NPI: 1851603476
Provider Name (Legal Business Name): MICHELLE HARDENBROOK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SW GRIFFITH DR STE 104
BEAVERTON OR
97005-8700
US

IV. Provider business mailing address

4800 SW GRIFFITH DR STE 104
BEAVERTON OR
97005-8700
US

V. Phone/Fax

Practice location:
  • Phone: 971-727-8154
  • Fax: 971-246-5094
Mailing address:
  • Phone: 971-727-8154
  • Fax: 971-246-5094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number201703070NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: