Provider Demographics
NPI:1134407364
Name:FAULCONER, NIKKI CLAIRE (RN)
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:CLAIRE
Last Name:FAULCONER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 W JADON DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-1688
Mailing Address - Country:US
Mailing Address - Phone:541-401-8029
Mailing Address - Fax:
Practice Address - Street 1:759 27TH AVE
Practice Address - Street 2:
Practice Address - City:SWEET HOME
Practice Address - State:OR
Practice Address - Zip Code:97386-2994
Practice Address - Country:US
Practice Address - Phone:541-619-8697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201141800RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse