Provider Demographics
NPI:1518111053
Name:BINGHAM, NINA
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5819 NE GLISAN ST
Mailing Address - Street 2:APT. 410
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-3776
Mailing Address - Country:US
Mailing Address - Phone:503-935-3444
Mailing Address - Fax:
Practice Address - Street 1:5819 NE GLISAN ST
Practice Address - Street 2:APT. 410
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-3776
Practice Address - Country:US
Practice Address - Phone:503-935-3444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372600000X
OR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No372600000XNursing Service Related ProvidersAdult Companion