Provider Demographics
NPI:1043241144
Name:PASHEK, NICOLE M (ARNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:PASHEK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 E. 19TH ST
Mailing Address - Street 2:PO BOX 1520
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-0000
Mailing Address - Country:US
Mailing Address - Phone:541-506-6940
Mailing Address - Fax:541-506-6937
Practice Address - Street 1:1825 E. 19TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058
Practice Address - Country:US
Practice Address - Phone:541-506-6940
Practice Address - Fax:541-506-6937
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003817363L00000X, 363LA2200X, 363LG0600X
OR200850161NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0155780OtherL&I PIN
OR218105Medicaid
WAU19448OtherREGENCE BLUE SHIELD PIN
WA9632506Medicaid
WAU19448OtherREGENCE BLUE SHIELD PIN
WA0155780OtherL&I PIN
WA9632506Medicaid