Provider Demographics
NPI:1851361281
Name:RICH, NANCY COBURN (RN MSN PMHNP ARNP)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:COBURN
Last Name:RICH
Suffix:
Gender:F
Credentials:RN MSN PMHNP ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 82091
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97282-0091
Mailing Address - Country:US
Mailing Address - Phone:503-231-4581
Mailing Address - Fax:503-239-3897
Practice Address - Street 1:5130 SE 34TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202
Practice Address - Country:US
Practice Address - Phone:503-231-4581
Practice Address - Fax:503-239-3897
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005557163W00000X
OR084060674N6363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR079140Medicaid
ORR112548Medicare ID - Type Unspecified