Healthcare Provider Details

I. General information

NPI: 1215485982
Provider Name (Legal Business Name): RICHARD NILE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 HARTMAN LN STE 200
SPRINGFIELD OR
97477-1122
US

IV. Provider business mailing address

390 9TH ST
FLORENCE OR
97439-9470
US

V. Phone/Fax

Practice location:
  • Phone: 541-334-3350
  • Fax: 541-746-4569
Mailing address:
  • Phone: 541-997-7134
  • Fax: 541-997-1336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: