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NPI Code Detail

MEDICARE: NIKKI BLOMQUIST

MEDICARE: NIKKI BLOMQUIST
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor05-11-105OR

General Provider Information

NPI Number : 1053476408
Entity Type Code : Individual
Provider Name (Legal Business Name) : NIKKI BLOMQUIST
Provider Business Mailing Address
First Line : 524 MAIN ST
Second Line :
City : OREGON CITY
State : OR
Zip : 97045-1824
Country : US
Telephone Number : 503-655-8558
Fax Number : 503-655-8197
Provider Business Practice Location Address
First Line : 524 MAIN ST
Second Line :
City : OREGON CITY
State : OR
Zip : 97045-1824
Country : US
Telephone Number : 503-655-8558
Fax Number : 503-655-8197
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/26/2006
Last Update Date : 07/08/2007

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Directions to “ NIKKI BLOMQUIST ” Practice Location

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