Brenda Backhaus, RN

Individual provider Active NPI General Practice Registered Nurse · Gladstone, OR

NPI 1982124970 · NPPES record last updated Jul 21, 2022

Key facts

NPI
1982124970
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Registered Nurse 163WG0000X
License
200240922RN (OR)
Practice address
5935 Sladen Ave
Gladstone, OR 97027-1952
Phone
(503) 740-5935
Fax
(503) 212-0175
NPI assigned
Jun 21, 2017
Sex
Female
Sole proprietor
Yes

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

LicenseStateTypeSpecialty
200240922RNORMDGeneral Practice Registered Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Registered Nurse 163WG0000X 200240922RN OR Yes

Addresses

Primary practice location

5935 Sladen Ave
Gladstone, OR 97027-1952

Mailing address

5935 Sladen Ave
Gladstone, OR 97027-1952
Phone (503) 740-5935

Other providers in Gladstone, OR

All providers in Gladstone, OR · General Practice Registered Nurse in Oregon

Sources for this page

Verify at the official NPI Registry.