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General NPI Number Information
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NPI Number | 1144518788
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Entity Type | Individual
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Provider Name | NICOLE FAYE DRAHUSCHAK NP-C
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Gender | Female
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Dates
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Enumeration Date | 07/18/2011
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Last Update Date | 08/05/2019
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Provider Practice Location Address
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Address Line | 3377 RIVERBEND DR
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City | SPRINGFIELD
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State | OR
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Zip | 97477
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Country | US
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Telephone | 541-222-6200
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Fax | 541-222-6182
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Provider Business Mailing Address
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Address Line | 1115 SE 164TH AVE DEPT 358
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City | VANCOUVER
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State | WA
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Zip | 98683-8004
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Country | US
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Telephone | 360-729-1253
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Fax | 360-729-3185
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 201901042NP-PP
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R895787
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License Number State | MS
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