Provider Demographics
NPI:1912233032
Name:DAHL, MICHELLE (PMHNP-BC, MSN,MA, RN)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:DAHL
Suffix:
Gender:F
Credentials:PMHNP-BC, MSN,MA, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 NE HANCOCK ST STE 218
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-5321
Mailing Address - Country:US
Mailing Address - Phone:503-782-1963
Mailing Address - Fax:503-987-5977
Practice Address - Street 1:3939 NE HANCOCK ST STE 218
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-5321
Practice Address - Country:US
Practice Address - Phone:503-782-1963
Practice Address - Fax:503-987-5977
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61070949363LP0808X
TN14474363LP0808X
OR201506948NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500694332Medicaid
OR500694332Medicaid