Mcdaniel, Nicole Marie

Mcdaniel, Nicole Marie is an individual health care provider with primary practice located at 530 Nw 23Rd Ave Suite #116, Portland OR 97210-3275. She recently has only one registered license in Other Service Providers / Specialist, which is considered as her primary health care specialty. Mcdaniel, Nicole Marie can be contacted via phone (971) 258-0995.

Contact Information

Primary practice address
530 Nw 23Rd Ave Suite #116 Portland OR 97210-3275
Phone: (971) 258-0995
Fax: (844) 364-4344
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 5138 Oregon

Profile Details

NPI number 1104826601
LBN Legal business name Mcdaniel, Nicole Marie
Credentials Physical Therapist (PT)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 26th, 2005
Last updated Feb 20th, 2017 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104826601 NPPES
New Mexico MEDICAID 17657385
New Mexico Other 2914

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