Individual
KRISTEN ELISE NICOLESCU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
551 LONE PINE BLVD STE 302, THE DALLES, OR 97058-9404
(541) 506-6500
(541) 506-6501
Mailing address
PO BOX 1520, THE DALLES, OR 97058-8003
(541) 298-7971
(541) 296-6431
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA159795
OR
363A00000X
Physician Assistant
PA4277
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500654260
—
OR
Enumeration date
10/30/2011
Last updated
10/31/2013
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