Octavia M Nightingale

Primary specialty

Pediatric Skilled Nursing FacilityTaxonomy code 3140N1450X

License

513068 Issued in OR

Practice address

4190 Collins Way
Lake Oswego, OR 97035-3448

Phone

(503) 636-0966

Fax

(503) 675-3552

NPI assigned

Nov 2, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1604275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604275200000",
    "number": "1225639826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4190 COLLINS WAY",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970353448",
            "telephone_number": "503-636-0966",
            "fax_number": "503-675-3552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4190 COLLINS WAY",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970353448",
            "telephone_number": "503-636-0966",
            "fax_number": "503-675-3552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIGHTINGALE",
        "first_name": "OCTAVIA",
        "middle_name": "M",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-11-02",
        "last_updated": "2020-11-02",
        "certification_date": "2020-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3140N1450X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility, Nursing Care, Pediatric",
            "state": "OR",
            "license": "513068",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "513068",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicholas G. Dose, DMD, PC
• Jennifer Nickell, MS, RD, LD
• Justin Ernest Albarracin Nicolas
• Tristan Nieto
• Jennifer L Nieves
• Leeza Noble
• Node & Nectar Counseling LLC
• Viengkeo T Noimany, DPM
• Laila Marie-Nematbaksh Noll, D.C.
• Jane Tharpe Norman

• Pediatric Skilled Nursing Facility in Lake Oswego, OR
• Providers in Lake Oswego, OR by specialty
• Pediatric Skilled Nursing Facility in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.