Healthcare Provider Details

I. General information

NPI: 1013337211
Provider Name (Legal Business Name): MICHELLE MCINTYRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2014
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NW 11TH ST STE E37
HERMISTON OR
97838-8604
US

IV. Provider business mailing address

600 NW 11TH ST STE E37
HERMISTON OR
97838-8604
US

V. Phone/Fax

Practice location:
  • Phone: 541-567-5305
  • Fax: 541-667-8763
Mailing address:
  • Phone: 541-567-5305
  • Fax: 541-667-3763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number201403682NP-PP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200742439RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: