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General NPI Number Information
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NPI Number | 1255954277
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Entity Type | Individual
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Provider Name | NICOLE L DANE PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/26/2020
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | 345 N GRANT ST
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City | CANBY
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State | OR
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Zip | 97013-3689
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Country | US
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Telephone | 503-266-2066
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Fax | 503-263-8719
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Provider Business Mailing Address
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Address Line | 345 N GRANT ST
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City | CANBY
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State | OR
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Zip | 97013-3610
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Country | US
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Telephone | 360-393-9752
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | PA211194
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA211194
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA211194
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License Number State | OR
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