Provider Demographics
NPI:1043009228
Name:TSIVIKAS, NICOLETTE (RN)
Entity type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:
Last Name:TSIVIKAS
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8927 N GENEVA AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-2603
Mailing Address - Country:US
Mailing Address - Phone:916-606-9585
Mailing Address - Fax:
Practice Address - Street 1:8927 N GENEVA AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-2603
Practice Address - Country:US
Practice Address - Phone:916-606-9585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60772656163W00000X
OR201704034RN163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163W00000XNursing Service ProvidersRegistered Nurse