Provider Demographics
NPI:1073327250
Name:EASTSIDE NURSE DELEGATION
Entity type:Organization
Organization Name:EASTSIDE NURSE DELEGATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE DELEGATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:COLLYN
Authorized Official - Last Name:PREHN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:503-351-0593
Mailing Address - Street 1:3703 NE 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-5128
Mailing Address - Country:US
Mailing Address - Phone:503-351-0593
Mailing Address - Fax:
Practice Address - Street 1:3703 NE 69TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-5128
Practice Address - Country:US
Practice Address - Phone:503-351-0593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty