Wydra, Nicole Dianne

Wydra, Nicole Dianne is an individual health care provider with primary practice located at 1740 Nw 9Th St , Corvallis OR 97330-2141. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Medical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Medical is her primary health care specialty. Wydra, Nicole Dianne can be contacted via phone (541) 230-1350.

Contact Information

Primary practice address
1740 Nw 9Th St Corvallis OR 97330-2141
Phone: (541) 230-1350
Fax: (541) 207-3477
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA153450 Oregon
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X

Profile Details

NPI number 1962514836
LBN Legal business name Wydra, Nicole Dianne
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 31st, 2006
Last updated Nov 3rd, 2015 - about 11 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 1962514836 NPPES
Oregon MEDICAID 500617735

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