Healthcare Provider Details

I. General information

NPI: 1841673670
Provider Name (Legal Business Name): MICHAEL ROCHLIN R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2015
Last Update Date: 06/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 NW 19TH AVE APT 610
PORTLAND OR
97209-2088
US

IV. Provider business mailing address

550 NW 19TH AVE APT 610
PORTLAND OR
97209-2088
US

V. Phone/Fax

Practice location:
  • Phone: 206-427-1048
  • Fax:
Mailing address:
  • Phone: 206-427-1048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number201143536RN
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number201143536RN
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number201143536RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: