Individual
NICOLE KNIGGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
417 SW 117TH AVE, 2ND FLOOR, PORTLAND, OR 97225-5924
(503) 216-9400
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA170872
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01522451
RR MEDICARE (PROVIDENCE)
OR
Enumeration date
11/21/2013
Last updated
01/29/2016
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