1457245474 NPI number — MR. ROBERT STOKES NICHOLSON RN

Table of content: MR. ROBERT STOKES NICHOLSON RN (NPI 1457245474)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457245474 NPI number — MR. ROBERT STOKES NICHOLSON RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NICHOLSON
Provider First Name:
ROBERT
Provider Middle Name:
STOKES
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457245474
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1715 NE 51ST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97213-2705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-346-6625
Provider Business Mailing Address Fax Number:
503-257-1779

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2735 NE 82ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97220-5304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-916-5220
Provider Business Practice Location Address Fax Number:
503-916-2702
Provider Enumeration Date:
06/04/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  201507791RN , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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