Provider Demographics
NPI:1962891341
Name:KINZER, NICHOLE
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:KINZER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 NW AMBERGLEN PKWY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-6980
Mailing Address - Country:US
Mailing Address - Phone:971-327-4356
Mailing Address - Fax:971-228-2177
Practice Address - Street 1:1920 NW AMBERGLEN PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-6980
Practice Address - Country:US
Practice Address - Phone:971-327-4356
Practice Address - Fax:971-228-2177
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other