NICKI NABAVIZADEH (NPI# 1114346442) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114346442 |
| Entity Type | Individual |
| Full Name | NICKI NABAVIZADEH |
| Credential | MD |
| Practice Address |
25050 Se Stark St Ste 300 Gresham OR 97030-3388 |
| Practice Telephone | 5036678878 |
| Mailing Telephone | 5036678878 |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2019-04-23 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | 813100 | OR | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3181 Sw Sam Jackson Park Rd, Portland, OR 972393011 | 5034948211 |
| Street Address |
25050 SE STARK ST STE 300 |
| City | GRESHAM |
| State | OR |
| Zip Code | 97030-3388 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053636001 | Jamie Williams | Counselor | 25050 Se Stark St Ste 300, Gresham, OR 97030-3388 | 2010-04-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174032312 | Tiffany Chen | Occupational Therapist | 304 Ne Hood Ave., Gresham, OR 97030 | 2017-09-20 |
| 1225568454 | Goldstar Vascular Access, Inc | Home Infusion | 2870 Ne Hogan Dr, Ste E #205, Gresham, OR 97030 | 2017-06-20 |
| 1861940454 | Jessica Morrow | Massage Therapist | 1748 Nw Fairview Dr., Gresham, OR 97030 | 2016-09-13 |
| 1033665898 | Bonita Baxter | Counselor | 400 Ne 7th Street, Gresham, OR 97030 | 2016-08-31 |
| 1710335484 | Ethan William Hoccom | Counselor | 1527 Ne Lamesa Place 17th St, Gresham, OR 97030 | 2016-06-02 |
| 1992159610 | Kathleen Kline, Lmt | Massage Therapist | 1217 Ne Burnside Road Suite 701-d, Gresham, OR 97030 | 2016-04-19 |
| 1215390109 | The Wallace Medical Concern | Nurse Practitioner | 254 Nw Burnside Road, Gresham, OR 97030 | 2016-03-30 |
| 1932568912 | Atchison Dialysis, LLC | Clinic/Center | 878 Nw Burnside Rd, Gresham, OR 97030 | 2016-02-18 |
| 1912374034 | Hilary Dawn Montgomery | Counselor | 1326 Nw Civic Dr # 5569, Gresham, OR 97030 | 2015-08-24 |
| 1992171730 | Melissa E Childs | Massage Therapist | 1217 Nw Burnside Rd Ste 701, Gresham, OR 97030 | 2015-08-17 |
| Find all providers in zip 97030 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891126538 | Sydmarie Bisenius | Pediatrics | 24850 Se Stark St Ste 150, Gresham, OR 97030-8318 | 2013-12-05 |
| 1326241241 | Stephanie Sari | Pediatrics | 24988 Se Stark St Ste 200, Gresham, OR 97030-8324 | 2007-06-07 |
| 1568592913 | Pediatric Associates of Gresham PC | Pediatrics | 2150 Ne Division St Ste 103, Gresham, OR 97030-5858 | 2007-03-06 |
| 1366592214 | Norman Toshiaki Eki | Pediatrics | 1326 Nw Civic Dr, Gresham, OR 97030-5569 | 2007-01-11 |
| 1942215678 | Denise D Kinstetter | Pediatrics | 1217 Ne Burnside, Ste 301, Gresham, OR 97030 | 2006-07-30 |
| 1942246046 | Kenneth Owen Fennell | Pediatrics | 24850 Se Stark, Ste 150, Gresham, OR 97030 | 2006-06-20 |
| 1477555860 | Peter R Gyerko | Pediatrics | 24988 Se Stark St, Suite 200, Gresham, OR 97030-8322 | 2005-08-15 |
| 1720089022 | Hildegard A.e. Schone | Pediatrics | 25500 Se Stark St., Suite 102, Gresham, OR 97030 | 2005-08-09 |
| 1164426110 | Julia W Mason | Pediatrics | 24850 Se Stark St, Suite 150, Gresham, OR 97030-8316 | 2005-06-08 |
| 1255764379 | Alexander Herman Lau | Pediatrics | 25050 Se Stark St, Ste 300, Gresham, OR 97030-3383 | 2013-08-13 |
| Find all providers in GRESHAM | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.