Individual
SUJAY NAKKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
706 MEADOW AVE, TILLAMOOK, OR 97141-2844
(503) 354-2523
(503) 354-5116
Mailing address
706 MEADOW AVE, TILLAMOOK, OR 97141-2844
(503) 354-2523
(503) 354-5116
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
500697789
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
500697789
OREGON HEALTH AUTHORITY
OR
Enumeration date
08/17/2016
Last updated
08/17/2016
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