Individual
NICOLE L DUSENBURY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5050 SKYLINE VILLAGE LOOP S, SALEM, OR 97306-9490
(035) 391-1110
(503) 370-4237
Mailing address
5050 SKYLINE VILLAGE LOOP S, SALEM, OR 97306-9490
(035) 391-1110
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
014584-1
NY
363A00000X
Physician Assistant
AMD -- 581
HI
363A00000X
Physician Assistant
MA054809
PA
363A00000X
Physician Assistant
Primary
PA207501
OR
Other
Enumeration date
06/21/2010
Last updated
07/11/2022
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