Provider Demographics
NPI:1093706186
Name:NICOLAI, PAUL JEFFREY (ND)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JEFFREY
Last Name:NICOLAI
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5933 NE WIN SIVERS DR
Mailing Address - Street 2:SUITE 226
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-9056
Mailing Address - Country:US
Mailing Address - Phone:503-200-5231
Mailing Address - Fax:503-200-5746
Practice Address - Street 1:5933 NE WIN SIVERS DR
Practice Address - Street 2:SUITE 226
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-9056
Practice Address - Country:US
Practice Address - Phone:503-200-5231
Practice Address - Fax:503-200-5746
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-29
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1330175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR275315OtherOMAP