Individual
MICHAEL ALAN NICHOLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRM
Contact information
Practice address
704 MAIN ST, OREGON CITY, OR 97045-1842
(971) 386-3415
(503) 208-2596
Mailing address
PO BOX 16756, PORTLAND, OR 97292-0756
(503) 208-2596
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
15-CRM-008
OR
Other
Enumeration date
02/22/2017
Last updated
02/22/2017
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