1619043833 NPI number — MRS. NIKKI RENEE EHRMANTROUT MS QMHP

Table of content: MRS. NIKKI RENEE EHRMANTROUT MS QMHP (NPI 1619043833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619043833 NPI number — MRS. NIKKI RENEE EHRMANTROUT MS QMHP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EHRMANTROUT
Provider First Name:
NIKKI
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS QMHP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FULKS
Provider Other First Name:
NICHOLE
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619043833
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JASPER
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-726-8819
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
576 OLIVE STREET SUITE 307
Provider Second Line Business Practice Location Address:
DIRECTION SERVICE COUNSELING CENTER
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-344-7303
Provider Business Practice Location Address Fax Number:
541-686-6283
Provider Enumeration Date:
11/28/2006

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 037759 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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