| Nicole Dianne Wydra, PA-C | |
|
1740 Nw 9th St, Corvallis, OR 97330-2141 | |
| (541) 230-1350 | |
| (541) 207-3477 |
| Full Name | Nicole Dianne Wydra |
|---|---|
| Gender | Female |
| Speciality | Physician Assistant |
| Experience | 14 Years |
| Location | 1740 Nw 9th St, Corvallis, Oregon |
| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962514836 | NPI | - | NPPES |
| 500617735 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363AM0700X | Physician Assistant - Medical | PA153450 (Oregon) | Primary |
| 363A00000X | Physician Assistant | (* (Not Available)) | Secondary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Good Samaritan Regional Medical Center | Corvallis, OR | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Brune Dermatology, Llc | 8628266301 | 5 |
| Mailing Address | Practice Location Address |
|---|---|
| Nicole Dianne Wydra, PA-C 1740 Nw 9th St, Corvallis, OR 97330-2141 Ph: () - | Nicole Dianne Wydra, PA-C 1740 Nw 9th St, Corvallis, OR 97330-2141 Ph: (541) 230-1350 |
Michael J Mccusker, P. A.-C Physician Assistant Medicare: Medicare Enrolled Practice Location: 530 Nw 27th St, Corvallis, OR 97330 Phone: 541-766-6611 Fax: 541-766-6186 | |
Ms. Stacie Marie Fulcher, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 444 Nw Elks Drive, Corvallis, OR 97330 Phone: 541-754-1256 Fax: 360-597-1472 | |
Gregory Miller, Physician Assistant Medicare: Medicare Enrolled Practice Location: 3640 Nw Samaritan Dr Ste 100, Corvallis, OR 97330 Phone: 541-768-5205 | |
Taylor Frank, PA-C Physician Assistant Medicare: Medicare Enrolled Practice Location: 3640 Nw Samaritan Dr Ste 120, Corvallis, OR 97330 Phone: 541-768-5223 | |
John Narciso Navarro, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 3680 Nw Samaritan Dr, Corvallis, OR 97330 Phone: 541-754-1150 | |
Beth Anne Rathbun, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 444 Nw Elks Dr, Corvallis, OR 97330 Phone: 541-754-1287 | |
Ms. Annemarie Boyd, PA-C Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 3680 Nw Samaritan Dr, Corvallis, OR 97330 Phone: 541-754-1150 |