Healthcare Provider Details

I. General information

NPI: 1801155320
Provider Name (Legal Business Name): NICHOLE ALEXANDRIA PILAKOWSKI DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2012
Last Update Date: 05/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 S PINE ST
CARLTON OR
97111-1169
US

IV. Provider business mailing address

PO BOX 18
CARLTON OR
97111-0018
US

V. Phone/Fax

Practice location:
  • Phone: 503-852-7009
  • Fax: 503-852-6662
Mailing address:
  • Phone: 503-852-7009
  • Fax: 503-852-6662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number6158
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: