Provider Demographics
NPI:1740797570
Name:MIDNIGHT, OLEANDER
Entity Type:Individual
Prefix:MS
First Name:OLEANDER
Middle Name:
Last Name:MIDNIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ROBIN
Other - Middle Name:MICHELLE
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3990 COLLINS WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3480
Mailing Address - Country:US
Mailing Address - Phone:503-635-1236
Mailing Address - Fax:
Practice Address - Street 1:1413 SE HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214
Practice Address - Country:US
Practice Address - Phone:503-841-6460
Practice Address - Fax:971-350-3380
Is Sole Proprietor?:No
Enumeration Date:2018-01-02
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16868225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist