1588391973 NPI number — VICKIE LYNN NICKELS TRADITIONAL MIDWIFE

Table of content: VICKIE LYNN NICKELS TRADITIONAL MIDWIFE (NPI 1588391973)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588391973 NPI number — VICKIE LYNN NICKELS TRADITIONAL MIDWIFE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NICKELS
Provider First Name:
VICKIE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
TRADITIONAL MIDWIFE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NICKELS
Provider Other First Name:
VICTORIA
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1588391973
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
224 SCHOONER BAY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKINGS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97415-9061
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-661-4652
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
224 SCHOONER BAY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKINGS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97415-9061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-661-4652
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/04/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 175M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2022-0025 . This is a "OREGON HEALTH AUTHORITY MIDWIFE NUMBER" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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