Individual
JOSHUA RYAN NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1111 NE 99TH AVE STE 301, PORTLAND, OR 97220-9442
(503) 963-2707
(503) 963-2802
Mailing address
541 NE 20TH AVE STE 225, PORTLAND, OR 97232-2895
(503) 963-2801
(503) 963-2825
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA190184
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2181438
—
WA
05
—
500753922
—
OR
Enumeration date
10/08/2018
Last updated
11/04/2024
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