Individual
MRS. NICOLE DEGENNARO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
QMHA
Contact information
Practice address
530 NW 27TH ST, CORVALLIS, OR 97330-5298
(541) 766-6835
Mailing address
PO BOX 579, CORVALLIS, OR 97339-0579
(541) 766-6835
(541) 766-6186
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
21-QMHA-R-1327
OR
Other
Enumeration date
07/30/2021
Last updated
11/04/2025
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