Healthcare Provider Details

I. General information

NPI: 1669357786
Provider Name (Legal Business Name): MONIKA BILLE SEIDLITZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2025
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7133 N LOMBARD ST STE 101
PORTLAND OR
97203-3205
US

IV. Provider business mailing address

7133 N LOMBARD ST
PORTLAND OR
97203-3205
US

V. Phone/Fax

Practice location:
  • Phone: 971-263-1891
  • Fax: 503-328-7990
Mailing address:
  • Phone: 971-263-1891
  • Fax: 503-328-7990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number201906163RN
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201906163RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: