Provider Demographics
NPI:1497894356
Name:WERNECKE, NANCY LEE (PMHNP)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:LEE
Last Name:WERNECKE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MONROE PARKWAY
Mailing Address - Street 2:SUITE 280
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-8867
Mailing Address - Country:US
Mailing Address - Phone:503-699-8550
Mailing Address - Fax:503-635-8411
Practice Address - Street 1:9 MONROE PKWY
Practice Address - Street 2:SUITE 280
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-1495
Practice Address - Country:US
Practice Address - Phone:503-699-8550
Practice Address - Fax:503-635-8411
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR120431Medicaid
ORS59111Medicare UPIN
OK102155Medicare ID - Type Unspecified