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General NPI Number Information
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NPI Number | 1821951088
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Entity Type | Individual
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Provider Name | NICOLE ROGERS
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Gender | Female
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Dates
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Enumeration Date | 12/04/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 3716 NE MARTIN LUTHER KING BLVD
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City | PORTLAND
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State | OR
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Zip | 97212-1111
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Country | US
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Telephone | 502-288-8036
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Fax |
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Provider Business Mailing Address
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Address Line | 5626 NE 36TH AVE
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City | PORTLAND
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State | OR
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Zip | 97211-7341
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Country | US
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Telephone | 503-706-6857
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Fax | 503-706-6857
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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