Basic Information
| Provider Information | |||||||||
| NPI: | 1174155980 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BIGHAM | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | ANTHONY | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 NE KENNETH FORD DR | ||||||||
| Address2: | |||||||||
| City: | ROSEBURG | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974701042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416729596 | ||||||||
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| Practice Location | |||||||||
| Address1: | 790 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MYRTLE CREEK | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974579303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416729596 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2020 | ||||||||
| LastUpdateDate: | 10/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 202009233NP-PP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.