Provider Demographics
NPI:1245634807
Name:MOHLER, NEREIDA (CMA)
Entity type:Individual
Prefix:
First Name:NEREIDA
Middle Name:
Last Name:MOHLER
Suffix:
Gender:F
Credentials:CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 EVANS ST
Mailing Address - Street 2:YAMHILL COUNTY HEALTH AND HUMAN SERVICES
Mailing Address - City:MCMINNIVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128
Mailing Address - Country:US
Mailing Address - Phone:503-434-7523
Mailing Address - Fax:503-434-9846
Practice Address - Street 1:627 NE EVANS ST
Practice Address - Street 2:
Practice Address - City:MCMINNIVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128
Practice Address - Country:US
Practice Address - Phone:503-434-7523
Practice Address - Fax:503-434-9846
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-10
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201211891CNA374700000X
OR0922-6010374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500686786Medicaid
OR1245634807Medicaid