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General NPI Number Information
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NPI Number | 1619957990
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Entity Type | Individual
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Provider Name | MICHELE NETH DICKSON ARNP
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Gender | Female
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Dates
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Enumeration Date | 01/20/2006
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Last Update Date | 07/17/2023
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Provider Practice Location Address
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Address Line | 12123 SW 69TH AVE
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City | TIGARD
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State | OR
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Zip | 97223-8514
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Country | US
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Telephone | 971-708-7600
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Fax | 971-371-5230
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Provider Business Mailing Address
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Address Line | 1498 SE TECH CENTER PL STE 240
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City | VANCOUVER
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State | WA
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Zip | 98683-5508
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Country | US
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Telephone |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN00105798
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | AP30003195
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | MD0118364
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License Number State | OR
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