Provider Demographics
NPI:1801876321
Name:MEDGHALCHY, NOOSHIN-NIKKI NIKKI (LAC)
Entity type:Individual
Prefix:MS
First Name:NOOSHIN-NIKKI
Middle Name:NIKKI
Last Name:MEDGHALCHY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9411 NE HWY 99
Mailing Address - Street 2:STE 1
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665
Mailing Address - Country:US
Mailing Address - Phone:360-571-8515
Mailing Address - Fax:360-571-8516
Practice Address - Street 1:9411 NE HWY 99
Practice Address - Street 2:STE 1
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665
Practice Address - Country:US
Practice Address - Phone:360-571-8515
Practice Address - Fax:360-571-8516
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000606171100000X
ORAC00502171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist