Individual
NICOLE E. MYERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
17 S 3RD ST, NYSSA, OR 97913-3815
(541) 372-5738
(541) 372-5732
Mailing address
17 S 3RD ST, NYSSA, OR 97913-3815
(541) 372-5738
(541) 372-5732
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA01135
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA01135
OREGON PA LICENSE
OR
Enumeration date
09/20/2006
Last updated
03/31/2008
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