Basic Information
| Provider Information | |||||||||
| NPI: | 1679965149 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MIDDLEKAUFF | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | DNP, BSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4858 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972084858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415002555 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1813 W HARVARD AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | ROSEBURG | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974712752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414406390 | ||||||||
| FaxNumber: | 5414406392 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2015 | ||||||||
| LastUpdateDate: | 06/22/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 201394824RN | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 201394824RN | 01 | OR | OREGON NURSING BOARD LICENSE | OTHER |