Provider Demographics
NPI:1407606445
Name:OBERT, NICOLE URSULA
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:URSULA
Last Name:OBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:URSULA
Other - Last Name:TUNTLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:200 UGGEN AVE
Mailing Address - Street 2:
Mailing Address - City:EPPING
Mailing Address - State:ND
Mailing Address - Zip Code:58843-4317
Mailing Address - Country:US
Mailing Address - Phone:503-943-0602
Mailing Address - Fax:
Practice Address - Street 1:200 UGGEN AVE
Practice Address - Street 2:
Practice Address - City:EPPING
Practice Address - State:ND
Practice Address - Zip Code:58843-4317
Practice Address - Country:US
Practice Address - Phone:503-943-0602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR53178163WX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0800XNursing Service ProvidersRegistered NurseOrthopedic