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NPI Code Detail

MEDICARE: MICHELLE G VANDER WAAL PMHNP

MEDICARE: MICHELLE G VANDER WAAL PMHNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor200350142NPOR

General Provider Information

NPI Number : 1295906915
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE G VANDER WAAL PMHNP
Provider Business Mailing Address
First Line : 3619 HIGHWAY 101 N
Second Line :
City : GEARHART
State : OR
Zip : 97138-4321
Country : US
Telephone Number : 503-738-3832
Fax Number : 503-738-3466
Provider Business Practice Location Address
First Line : 3619 HIGHWAY 101 N
Second Line :
City : GEARHART
State : OR
Zip : 97138-4321
Country : US
Telephone Number : 503-738-3832
Fax Number : 503-738-3466
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2008
Last Update Date : 03/20/2008

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