Provider Demographics
NPI:1235569278
Name:MCKENNA, NICOLE (FNP, RN, BSN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:FNP, RN, BSN
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:WEBBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2051 KAEN RD STE 367
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-4035
Mailing Address - Country:US
Mailing Address - Phone:503-742-5300
Mailing Address - Fax:503-742-5979
Practice Address - Street 1:1425 BEAVERCREEK RD
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-4076
Practice Address - Country:US
Practice Address - Phone:503-655-8471
Practice Address - Fax:503-723-4946
Is Sole Proprietor?:No
Enumeration Date:2013-11-12
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201041543RN163W00000X
OR201506515NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse