Holly Jean NG, RN
Individual provider Active NPI Pediatric Registered Nurse · Gates, OR
NPI 1750054169 · NPPES record last updated Jul 30, 2021
Key facts
- NPI
- 1750054169
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Registered Nurse 163WP0200X
- License
- 201403741 (OR)
- Practice address
- 39971 Gates School Rd
Gates, OR 97346-9604 - Phone
- (503) 509-8176
- NPI assigned
- Jul 30, 2021
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 201403741 | OR | MD | Pediatric Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Registered Nurse | 163WP0200X | 201403741 | OR | Yes |
Addresses
Primary practice location
39971 Gates School Rd
Gates, OR 97346-9604
Mailing address
PO Box 525
Gates, OR 97346-0525
Phone (503) 509-8176
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 30, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.