Provider Demographics
NPI:1821525080
Name:NUGENT-BUCHANAN, MICHELLE DENISE (CRT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DENISE
Last Name:NUGENT-BUCHANAN
Suffix:
Gender:F
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 MARKET ST NE STE 541
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-1835
Mailing Address - Country:US
Mailing Address - Phone:971-301-8309
Mailing Address - Fax:971-301-8310
Practice Address - Street 1:3000 MARKET ST NE STE 541
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1835
Practice Address - Country:US
Practice Address - Phone:971-301-8309
Practice Address - Fax:971-301-8310
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-18
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0009382278G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2278G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGeneral CareGroup - Multi-Specialty