Provider Demographics
NPI:1952595936
Name:BEHNKE, NICOLE MK (MD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MK
Last Name:BEHNKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:11782 SW BARNES RD
Mailing Address - Street 2:STE 300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5933
Mailing Address - Country:US
Mailing Address - Phone:503-214-5200
Mailing Address - Fax:503-906-6613
Practice Address - Street 1:11782 SW BARNES RD STE 300
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5933
Practice Address - Country:US
Practice Address - Phone:503-214-5200
Practice Address - Fax:503-906-6613
Is Sole Proprietor?:No
Enumeration Date:2007-09-01
Last Update Date:2022-02-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORMD191204207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORMD191204OtherOREGON MEDICAL LICENSE