Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Providence Portland Medical Center

Organization Nurse Practitioner · NPI 1316199987

Providence Portland Medical Center is a Nurse Practitioner in Portland, Oregon. Registered with an NPI since 2008.

In the registry since
2008

Practice location Address checks out

4805 NE Glisan St
Portland, OR 97213-2933
Phone: (503) 215-6185
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X

Record details

NPI number1316199987
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Donald Anderson — Assistant Secretary Enrollments · (425) 358-9786
Other names Prov Nurse Practitioners East
NPI enumeratedOctober 15, 2008
Last updated in NPPESMay 7, 2025
Certification dateMay 7, 2025
Mailing addressPo Box 3158, Portland, OR 97208-3158

Other providers in Portland