Individual
KRISTINE R NILES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1086 7TH AVE SW STE 101, ALBANY, OR 97321-1954
(541) 812-5530
Mailing address
PO BOX 1189, CORVALLIS, OR 97339-1189
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA222457
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/07/2022
Last updated
10/28/2024
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