Provider Demographics
NPI:1659532141
Name:ADRIAN, ELLEN L (RN)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:L
Last Name:ADRIAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:B
Other - Last Name:ADRIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 16800
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97292-0800
Mailing Address - Country:US
Mailing Address - Phone:503-257-2500
Mailing Address - Fax:
Practice Address - Street 1:10123 SE MARKET ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2532
Practice Address - Country:US
Practice Address - Phone:503-257-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR080045239RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse