Individual
JOEY B. NICOLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
4455 NE HIGHWAY 20, CORVALLIS, OR 97330-9695
(541) 758-7722
Mailing address
4455 NE HIGHWAY 20, CORVALLIS, OR 97330-9695
(541) 758-7722
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
201817652LPN
OR
Other
Enumeration date
11/06/2023
Last updated
11/06/2023
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