Provider Demographics
NPI:1730914110
Name:NORWOOD, MONIQUE NICHOL (RN)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:NICHOL
Last Name:NORWOOD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:NICHOL
Other - Last Name:NORWOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPA, RN
Mailing Address - Street 1:8818 N DRUMMOND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-7126
Mailing Address - Country:US
Mailing Address - Phone:971-570-7730
Mailing Address - Fax:
Practice Address - Street 1:5257 NE MARTIN LUTHER KING JR BLVD STE 202F
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-3283
Practice Address - Country:US
Practice Address - Phone:971-570-7730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0940000615RN163W00000X
WA61152900163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty