Healthcare Provider Details

I. General information

NPI: 1922922236
Provider Name (Legal Business Name): DAVID NICOLI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 N ESTHER ST
NEWBERG OR
97132-9529
US

IV. Provider business mailing address

10470 SW RAYBORN CT
TUALATIN OR
97062-8623
US

V. Phone/Fax

Practice location:
  • Phone: 855-512-3909
  • Fax:
Mailing address:
  • Phone: 855-512-3909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: