Healthcare Provider Details

I. General information

NPI: 1427930007
Provider Name (Legal Business Name): ASHLEE MITCHELL GRIDER RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ASHLEE RASHELLE MITCHELL

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10180 SE SUNNYSIDE RD
CLACKAMAS OR
97015-8970
US

IV. Provider business mailing address

14082 SW 121ST AVE
TIGARD OR
97224-2817
US

V. Phone/Fax

Practice location:
  • Phone: 503-571-4694
  • Fax:
Mailing address:
  • Phone: 503-307-5792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number201906557RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: