Provider Demographics
NPI:1851603476
Name:HARDENBROOK, MICHELLE (NP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:HARDENBROOK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 SW GRIFFITH DR STE 104
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-8700
Mailing Address - Country:US
Mailing Address - Phone:971-727-8154
Mailing Address - Fax:971-246-5094
Practice Address - Street 1:4800 SW GRIFFITH DR STE 104
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-8700
Practice Address - Country:US
Practice Address - Phone:971-727-8154
Practice Address - Fax:971-246-5094
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201703070NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500733907Medicaid