Healthcare Provider Details

I. General information

NPI: 1043614167
Provider Name (Legal Business Name): ROBYN ELIZABETH NASH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 SE 164TH AVE
VANCOUVER WA
98683-8937
US

IV. Provider business mailing address

PO BOX 2928
PORTLAND OR
97208-2928
US

V. Phone/Fax

Practice location:
  • Phone: 888-227-3312
  • Fax: 360-216-4422
Mailing address:
  • Phone: 425-207-5155
  • Fax: 360-216-4422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA174022
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: