Healthcare Provider Details

I. General information

NPI: 1184237935
Provider Name (Legal Business Name): BRITTNEY TICE RN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2020
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 N WILLAMETTE BLVD
PORTLAND OR
97203-5743
US

IV. Provider business mailing address

1823 SW MARKET ST APT 1
PORTLAND OR
97201-2445
US

V. Phone/Fax

Practice location:
  • Phone: 503-943-7790
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number201142260RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10015389
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: