Provider Demographics
NPI:1619957990
Name:DICKSON, MICHELE NETH (ARNP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:NETH
Last Name:DICKSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1498 SE TECH CENTER PL STE 240
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-5508
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12123 SW 69TH AVE
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8514
Practice Address - Country:US
Practice Address - Phone:971-708-7600
Practice Address - Fax:971-371-5230
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00105798163W00000X
WAAP30003195363LW0102X
ORMD0118364363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA500018475OtherMEDICARE RR
WA9609454Medicaid
WA9609454Medicaid
WA500018475OtherMEDICARE RR