Individual
MR. ELLIOTT LOUIS KOIVISTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
7145 SW VARNS ST STE 206, TIGARD, OR 97223-8168
(971) 405-2584
(800) 785-4531
Mailing address
11785 SW ROBBINS DR, BEAVERTON, OR 97008-7949
(503) 522-2831
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
10005745
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
AP61377025
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10005745
OREGON STATE NURSING LICENSE
OR
01
—
201390875RN
OREGON STATE NURSING LICENSE NUMBER
OR
05
—
500819778
—
OR
01
—
AP61377025
WASHINGTON STATE DEPARTMENT OF HEALTH
WA
01
—
RN60545376
WASHINGTON STATE DEPARTMENT OF HEALTH
WA
Enumeration date
05/12/2022
Last updated
11/07/2025
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