Healthcare Provider Details

I. General information

NPI: 1265392500
Provider Name (Legal Business Name): BENIDA MONIQUE PANIAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MONIQUE NISHAN NP

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1241 NE 6TH ST
GRESHAM OR
97030-7340
US

IV. Provider business mailing address

4653 CARMEL MOUNTAIN RD STE 308
SAN DIEGO CA
92130-6650
US

V. Phone/Fax

Practice location:
  • Phone: 507-629-2774
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10060975
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: