Healthcare Provider Details

I. General information

NPI: 1043241144
Provider Name (Legal Business Name): NICOLE M. PASHEK ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 02/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 E. 19TH ST
THE DALLES OR
97058
US

IV. Provider business mailing address

1825 E. 19TH ST PO BOX 1520
THE DALLES OR
97058-0000
US

V. Phone/Fax

Practice location:
  • Phone: 541-506-6940
  • Fax: 541-506-6937
Mailing address:
  • Phone: 541-506-6940
  • Fax: 541-506-6937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP30003817
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP30003817
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number200850161NP
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP30003817
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: