Individual
NICOLE FAYE DRAHUSCHAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
3377 RIVERBEND DR, SPRINGFIELD, OR 97477
(541) 222-6200
(541) 222-6182
Mailing address
1115 SE 164TH AVE DEPT 358, VANCOUVER, WA 98683-8004
(360) 729-1253
(360) 729-3185
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
201901042NP-PP
OR
363LF0000X
Family Nurse Practitioner
R895787
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04288876
—
MS
01
—
P01403841
RAILROAD MEDICARE
MS
Enumeration date
07/18/2011
Last updated
08/05/2019
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