Provider Demographics
NPI:1073773396
Name:SCHWARZKOPF, NANCY DENISE
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:DENISE
Last Name:SCHWARZKOPF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:DENISE
Other - Last Name:SHEPHERD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:619 SW 6TH AVE.
Mailing Address - Street 2:5TH FL
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2605
Mailing Address - Country:US
Mailing Address - Phone:503-988-7468
Mailing Address - Fax:509-454-3651
Practice Address - Street 1:2020 SE 182ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-5692
Practice Address - Country:US
Practice Address - Phone:503-988-5400
Practice Address - Fax:503-988-5668
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN13284163W00000X
WAAP60030458363LF0000X
OR201801253NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR022959Medicaid
WAG8874566OtherMEDICARE PTAN