Provider Demographics
NPI:1417095357
Name:MISCHKE NELL, KAREN A (WHCNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:MISCHKE NELL
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15566 SW PERIDOT WAY
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-8629
Mailing Address - Country:US
Mailing Address - Phone:503-579-6900
Mailing Address - Fax:503-640-5863
Practice Address - Street 1:620 SE OAK ST STE A
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4160
Practice Address - Country:US
Practice Address - Phone:503-648-0661
Practice Address - Fax:503-640-5863
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17818N7363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health