Basic Information
| Provider Information | |||||||||
| NPI: | 1245634807 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOHLER | ||||||||
| FirstName: | NEREIDA | ||||||||
| MiddleName: | |||||||||
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| Credential: | CMA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 627 EVANS ST | ||||||||
| Address2: | YAMHILL COUNTY HEALTH AND HUMAN SERVICES | ||||||||
| City: | MCMINNIVILLE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034347523 | ||||||||
| FaxNumber: | 5034349846 | ||||||||
| Practice Location | |||||||||
| Address1: | 627 NE EVANS ST | ||||||||
| Address2: | |||||||||
| City: | MCMINNIVILLE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034347523 | ||||||||
| FaxNumber: | 5034349846 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2014 | ||||||||
| LastUpdateDate: | 06/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 374700000X | 201211891CNA | OR | N | Nursing Service Related Providers | Technician | 374700000X | 0922-6010 | OR | Y | Nursing Service Related Providers | Technician |
ID Information
| ID | Type | State | Issuer | Description | 500686786 | 05 | OR | MEDICAID | 1245634807 | 05 | OR | MEDICAID |