Individual
NICOLE MARIE MCDANIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
530 NW 23RD AVE, SUITE #116, PORTLAND, OR 97210-3275
(971) 258-0995
(844) 364-4344
Mailing address
530 NW 23RD AVE, SUITE #116, PORTLAND, OR 97210-3287
(971) 258-0995
(844) 364-4344
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
5138
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
17657385
—
NM
01
—
2914
STATE OF NM REG & LICENS.
NM
Enumeration date
07/26/2005
Last updated
02/20/2017
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