Provider Demographics
NPI:1578663332
Name:TOKICH, PAULETTA J (ARNP, FNP)
Entity Type:Individual
Prefix:
First Name:PAULETTA
Middle Name:J
Last Name:TOKICH
Suffix:
Gender:F
Credentials:ARNP, FNP
Other - Prefix:
Other - First Name:POLLY
Other - Middle Name:J
Other - Last Name:TOKICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP, FNP
Mailing Address - Street 1:PO BOX 194
Mailing Address - Street 2:
Mailing Address - City:COQUILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97423-0194
Mailing Address - Country:US
Mailing Address - Phone:541-329-0144
Mailing Address - Fax:541-329-0142
Practice Address - Street 1:209 N CENTRAL BLVD
Practice Address - Street 2:
Practice Address - City:COQUILLE
Practice Address - State:OR
Practice Address - Zip Code:97423-1274
Practice Address - Country:US
Practice Address - Phone:541-329-0144
Practice Address - Fax:541-329-0142
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200840133RN163W00000X
WAAP30007496363LF0000X
OR200850010NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1407812365OtherNBMC GROUP NPI NUMBER
ORR0000WFBTVOtherMEDICARE GROUP PIN NUMBER
OR218436Medicaid
WA9652454Medicaid
OR1407812365OtherNBMC GROUP NPI NUMBER
OR218436Medicaid
ORR140703Medicare PIN
WAG8863626Medicare PIN
WAQ75874Medicare UPIN