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NPI Code Detail

MEDICARE: KAREN E NIBBLETT PMHNP, CNS

MEDICARE: KAREN E NIBBLETT PMHNP, CNS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner200450084 NPOR
2364SG0600XGerontology Clinical Nurse Specialist200470021CNSOR

General Provider Information

NPI Number : 1720255854
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAREN E NIBBLETT PMHNP, CNS
Provider Business Mailing Address
First Line : 13007 NE GLISAN ST
Second Line :
City : PORTLAND
State : OR
Zip : 97230-2545
Country : US
Telephone Number : 503-215-5600
Fax Number : 503-215-7864
Provider Business Practice Location Address
First Line : 13007 NE GLISAN ST
Second Line :
City : PORTLAND
State : OR
Zip : 97230-2545
Country : US
Telephone Number : 503-215-5600
Fax Number : 503-215-7864
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2008
Last Update Date : 09/30/2020

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