Individual
NICOLE MACKENZIE BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
700 NE MULTNOMAH ST, SUITE 275, PORTLAND, OR 97232-2131
(503) 729-1380
(503) 841-6343
Mailing address
700 NE MULTNOMAH ST, SUITE 275, PORTLAND, OR 97232-2131
(503) 729-1380
(503) 841-6343
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
200950088NP
OR
Other
Enumeration date
08/10/2009
Last updated
11/08/2016
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