Basic Information
| Provider Information | |||||||||
| NPI: | 1619957990 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DICKSON | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | NETH | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15950 SW MILLIKAN WAY | ||||||||
| Address2: | |||||||||
| City: | BEAVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036460161 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 15950 SW MILLIKAN WAY | ||||||||
| Address2: | |||||||||
| City: | BEAVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036460161 | ||||||||
| FaxNumber: | 5035266781 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2006 | ||||||||
| LastUpdateDate: | 07/24/2014 | ||||||||
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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 | 163W00000X | RN00105798 | WA | N | Nursing Service Providers | Registered Nurse | 363LF0000X | MD0118364 | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LW0102X | AP30003195 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | 500018475 | 01 | WA | MEDICARE RR | OTHER | 9609454 | 05 | WA | MEDICAID |