Healthcare Provider Details

I. General information

NPI: 1528972486
Provider Name (Legal Business Name): NICHOLE ANNE HUBBARD BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 N INTERSTATE AVE
PORTLAND OR
97227-1196
US

IV. Provider business mailing address

11580 SE 34TH AVE
MILWAUKIE OR
97222-6767
US

V. Phone/Fax

Practice location:
  • Phone: 800-813-2000
  • Fax:
Mailing address:
  • Phone: 218-341-4624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number201708923RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: