Individual
LAURA NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
865 SW VETERANS WAY, REDMOND, OR 97756-2583
(541) 382-4900
Mailing address
PO BOX 6048, BEND, OR 97708-6048
(541) 382-4900
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD179189
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500721410
—
OR
Enumeration date
05/11/2006
Last updated
01/26/2022
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