Healthcare Provider Details

I. General information

NPI: 1578427167
Provider Name (Legal Business Name): BROOKE NICOLE SPOTTS CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 N CLARK ST
CORNELIUS OR
97113-8120
US

IV. Provider business mailing address

3033 N CLARK ST
CORNELIUS OR
97113-8120
US

V. Phone/Fax

Practice location:
  • Phone: 503-803-3525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number10054143
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: