Provider Demographics
NPI:1255531638
Name:CAVANAUGH, NANCY ALEXANDRIA (PNP)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ALEXANDRIA
Last Name:CAVANAUGH
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:859 WHITE OAK AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-3608
Mailing Address - Country:US
Mailing Address - Phone:541-423-5332
Mailing Address - Fax:
Practice Address - Street 1:3617 S PACIFIC HWY
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-8957
Practice Address - Country:US
Practice Address - Phone:541-535-6239
Practice Address - Fax:541-512-1026
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201142758RN163WP0200X
OR201250005NP163WP0200X, 363LP0200X
AK220363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500648116Medicaid
ORR173833OtherMEDICARE PTAN
AKNP13731Medicaid