Provider Demographics
NPI:1396212460
Name:PRISCAL, NICOLE (ND)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:PRISCAL
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 SW 11TH AVE STE 525
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2131
Mailing Address - Country:US
Mailing Address - Phone:503-294-7070
Mailing Address - Fax:
Practice Address - Street 1:833 SW 11TH AVE STE 525
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2131
Practice Address - Country:US
Practice Address - Phone:503-294-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4207175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath