Provider Demographics
NPI:1588391973
Name:NICKELS, VICKIE LYNN (TRADITIONAL MIDWIFE)
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:LYNN
Last Name:NICKELS
Suffix:
Gender:F
Credentials:TRADITIONAL MIDWIFE
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:LYNN
Other - Last Name:NICKELS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:224 SCHOONER BAY DR
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-9061
Mailing Address - Country:US
Mailing Address - Phone:541-661-4652
Mailing Address - Fax:
Practice Address - Street 1:224 SCHOONER BAY DR
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9061
Practice Address - Country:US
Practice Address - Phone:541-661-4652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR2022-0025OtherOREGON HEALTH AUTHORITY MIDWIFE NUMBER