Healthcare Provider Details

I. General information

NPI: 1437505781
Provider Name (Legal Business Name): NICOLE MONTHEI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 05/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MULLINS DR SUITE A-1
LEBANON OR
97355-3982
US

IV. Provider business mailing address

100 MULLINS DR SUITE A-1
LEBANON OR
97355-3982
US

V. Phone/Fax

Practice location:
  • Phone: 541-451-6920
  • Fax: 541-451-6924
Mailing address:
  • Phone: 541-451-6920
  • Fax: 541-451-6924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201601298RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: