Basic Information
| Provider Information | |||||||||
| NPI: | 1043241144 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PASHEK | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1825 E. 19TH ST | ||||||||
| Address2: | PO BOX 1520 | ||||||||
| City: | THE DALLES | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970580000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415066940 | ||||||||
| FaxNumber: | 5415066937 | ||||||||
| Practice Location | |||||||||
| Address1: | 1825 E. 19TH ST | ||||||||
| Address2: | |||||||||
| City: | THE DALLES | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415066940 | ||||||||
| FaxNumber: | 5415066937 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 02/02/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AP30003817 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LA2200X | AP30003817 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LA2200X | 200850161NP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LG0600X | AP30003817 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
ID Information
| ID | Type | State | Issuer | Description | 0155780 | 01 | WA | L&I PIN | OTHER | 218105 | 05 | OR | MEDICAID | U19448 | 01 | WA | REGENCE BLUE SHIELD PIN | OTHER | 9632506 | 05 | WA | MEDICAID |