Individual
NICKOLAS PETRAGALLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRM/PSS
Contact information
Practice address
908 NE 4TH ST STE 101, BEND, OR 97701-4646
(541) 617-7365
Mailing address
908 NE 4TH ST STE 101, BEND, OR 97701-4646
(541) 617-7365
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
20-CRM-242
OR
Other
Enumeration date
10/05/2020
Last updated
10/05/2020
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