Healthcare Provider Details

I. General information

NPI: 1588988869
Provider Name (Legal Business Name): NYKOLE MARIE NASSHAHN B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NYKI NASSHAHN

II. Dates (important events)

Enumeration Date: 03/16/2010
Last Update Date: 03/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31637 SE DODGE PARK BLVD
GRESHAM OR
97080-8964
US

IV. Provider business mailing address

31637 SE DODGE PARK BLVD
GRESHAM OR
97080-8964
US

V. Phone/Fax

Practice location:
  • Phone: 541-510-0592
  • Fax:
Mailing address:
  • Phone: 541-510-0592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: