Provider Demographics
NPI:1225382872
Name:FLECK, ULRIKE MARIANNE (RN)
Entity Type:Individual
Prefix:
First Name:ULRIKE
Middle Name:MARIANNE
Last Name:FLECK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 N 15TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILOMATH
Mailing Address - State:OR
Mailing Address - Zip Code:97370-9128
Mailing Address - Country:US
Mailing Address - Phone:541-929-5415
Mailing Address - Fax:
Practice Address - Street 1:134 N 15TH ST
Practice Address - Street 2:
Practice Address - City:PHILOMATH
Practice Address - State:OR
Practice Address - Zip Code:97370-9128
Practice Address - Country:US
Practice Address - Phone:541-929-5415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR096000555RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse