Healthcare Provider Details

I. General information

NPI: 1740838101
Provider Name (Legal Business Name): PAUL BORING NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2019
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3769 SE MILWAUKIE AVE
PORTLAND OR
97202-3804
US

IV. Provider business mailing address

3769 SE MILWAUKIE AVE
PORTLAND OR
97202-3804
US

V. Phone/Fax

Practice location:
  • Phone: 503-206-8850
  • Fax:
Mailing address:
  • Phone: 503-206-8850
  • Fax: 503-460-0434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10054266
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: