Provider Demographics
NPI:1558452599
Name:CONFORTI, NIRMAL KAUR
Entity Type:Individual
Prefix:
First Name:NIRMAL
Middle Name:KAUR
Last Name:CONFORTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61621 WOODRIVER DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-2042
Mailing Address - Country:US
Mailing Address - Phone:541-668-5288
Mailing Address - Fax:
Practice Address - Street 1:61621 WOODRIVER DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1396
Practice Address - Country:US
Practice Address - Phone:541-668-5288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL61601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2353528000OtherIBC
PA7551402OtherAETNA
PA455939000OtherKEYSTONE