Individual
NIKKI RAE PROCTOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
735 S 2ND ST, CRESWELL, OR 97426-7507
(541) 895-3333
(360) 356-9020
Mailing address
735 S 2ND ST, CRESWELL, OR 97426-7507
(541) 895-3333
(360) 356-9020
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
201704153LPN
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
N/A
—
Enumeration date
12/01/2021
Last updated
12/01/2021
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