Healthcare Provider Details

I. General information

NPI: 1154671402
Provider Name (Legal Business Name): LINDA L MCPIKE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4531 SE BELMONT ST SUITE 100
PORTLAND OR
97215-1675
US

IV. Provider business mailing address

4531 SE BELMONT ST SUITE 100
PORTLAND OR
97215-1675
US

V. Phone/Fax

Practice location:
  • Phone: 503-760-2075
  • Fax: 503-548-2959
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number200740084RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: