Individual
OCTAVIA M NIGHTINGALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4190 COLLINS WAY, LAKE OSWEGO, OR 97035-3448
(503) 636-0966
(503) 675-3552
Mailing address
4190 COLLINS WAY, LAKE OSWEGO, OR 97035-3448
(503) 636-0966
(503) 675-3552
Taxonomy
Speciality
Code
Description
License number
State
3140N1450X
Pediatric Skilled Nursing Facility
Primary
513068
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
513068
—
OR
Enumeration date
11/02/2020
Last updated
11/02/2020
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