Healthcare Provider Details

I. General information

NPI: 1366096406
Provider Name (Legal Business Name): NICOLE W ENGEL RN BSN CNOR RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE M WARWICK RN

II. Dates (important events)

Enumeration Date: 07/26/2019
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4805 NE GLISAN ST
PORTLAND OR
97213-2933
US

IV. Provider business mailing address

4216 NE HOYT ST
PORTLAND OR
97213-1644
US

V. Phone/Fax

Practice location:
  • Phone: 971-269-8951
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number201393923RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: