RENAE RYKACZEWSKI (NPI# 1053895110) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053895110 |
| Entity Type | Individual |
| Full Name | RENAE RYKACZEWSKI |
| Credential | FNP-C |
| Practice Address |
600 Ne 8th St Ste 300 Gresham OR 97030-7318 |
| Mailing Address |
6120 N Concord Ave Portland OR 97217-4735 |
| Practice Telephone | 5309885155 |
| Mailing Telephone | 3235809119 |
| Enumeration Date | 2018-09-24 |
| Last Update Date | 2019-07-01 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
201807432NP-PP | OR | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 1053895110 | 05 |
| Street Address |
600 NE 8TH ST STE 300 |
| City | GRESHAM |
| State | OR |
| Zip Code | 97030-7318 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922338789 | Sara Kline Mitenbuler | Nurse Practitioner | 600 Ne 8th St Ste 300, Gresham, OR 97030-7318 | 2009-12-30 |
| 1174140511 | Lacey M Hudson | Dental Assistant | 600 Ne 8th St Ste 300, Gresham, OR 97030-7318 | 2020-07-01 |
| 1972120467 | Corina Lynn Copher | Pharmacy Technician | 600 Ne 8th St Ste 300, Gresham, OR 97030-7318 | 2020-06-30 |
| 1396252524 | Candice Lyn Hunter | Nurse Practitioner | 600 Ne 8th St Ste 300, Gresham, OR 97030-7318 | 2018-01-09 |
| 1528575388 | Luis Adan Sanchez | Nurse Practitioner | 600 Ne 8th St Ste 300, Gresham, OR 97030-7318 | 2018-01-02 |
| 1366812372 | Tyler Clark Chipman | Nurse Practitioner | 600 Ne 8th St Ste 300, Gresham, OR 97030-7318 | 2015-10-02 |
| 1053615773 | Luz Maria Brousseau | Licensed Practical Nurse | 600 Ne 8th St Ste 300, Gresham, OR 97030-7318 | 2011-01-10 |
| 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 | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215390109 | The Wallace Medical Concern | Nurse Practitioner | 254 Nw Burnside Road, Gresham, OR 97030 | 2016-03-30 |
| 1679865729 | Rebecca Martinez | Nurse Practitioner | 600 Ne 8th, 3rd Floor, Gresham, OR 97030 | 2011-05-09 |
| 1922338789 | Sara Kline Mitenbuler | Nurse Practitioner | 600 Ne 8th St Ste 300, Gresham, OR 97030-7318 | 2009-12-30 |
| 1497750715 | Tatyana J Dembrow | Nurse Practitioner | 501 Ne Hood Ave, Suite 100, Gresham, OR 97030-7303 | 2005-06-14 |
| 1902468358 | Sara Miller | Nurse Practitioner | 600 Ne 8th St Fl 3, Gresham, OR 97030-7317 | 2019-07-06 |
| 1407312143 | Shellie Anne Yoshie Finck | Nurse Practitioner | 831 Nw Council Dr Ste 101, Gresham, OR 97030-3722 | 2019-02-19 |
| 1114407301 | Crystal Luna | Nurse Practitioner | 2850 Se Powell Valley Rd, Gresham, OR 97080 | 2018-08-16 |
| 1396252524 | Candice Lyn Hunter | Nurse Practitioner | 600 Ne 8th St Ste 300, Gresham, OR 97030-7318 | 2018-01-09 |
| 1528575388 | Luis Adan Sanchez | Nurse Practitioner | 600 Ne 8th St Ste 300, Gresham, OR 97030-7318 | 2018-01-02 |
| 1295248003 | Alexandra Marie Sigmon | Nurse Practitioner | 2850 Se Powell Valley Rd, Gresham, OR 97080-1494 | 2017-11-15 |
| 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.