Provider Demographics
NPI:1619224052
Name:SIMPSON, NICHOLE LYNN (RN)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:LYNN
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:LYNN
Other - Last Name:KINDRED
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:465 WAGONTIRE DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE CREEK
Mailing Address - State:OR
Mailing Address - Zip Code:97457-9757
Mailing Address - Country:US
Mailing Address - Phone:541-680-3386
Mailing Address - Fax:
Practice Address - Street 1:2700 NW STEWART PKWY
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-1281
Practice Address - Country:US
Practice Address - Phone:541-673-0611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201041992RN163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical