Healthcare Provider Details

I. General information

NPI: 1598620676
Provider Name (Legal Business Name): ROSE KIKEN RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 NE SUMNER ST
PORTLAND OR
97211-6263
US

IV. Provider business mailing address

2725 NE SUMNER ST
PORTLAND OR
97211-6263
US

V. Phone/Fax

Practice location:
  • Phone: 773-576-5902
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number201502282RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: