Healthcare Provider Details

I. General information

NPI: 1558452599
Provider Name (Legal Business Name): NIRMAL KAUR CONFORTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61621 WOODRIVER DR
BEND OR
97702-1396
US

IV. Provider business mailing address

61621 WOODRIVER DR
BEND OR
97702-2042
US

V. Phone/Fax

Practice location:
  • Phone: 541-668-5288
  • Fax:
Mailing address:
  • Phone: 541-668-5288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL6160
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: