| Provider / Organization | NPI | Date Certified |
|---|---|---|
| NICHOLAS FRANK TACKE | 1871056630 | 2019-04-09 |
Nicholas Frank Tacke is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1871056630. Registration indicates Nicholas Frank Tacke is a provider of access to mental health/behavioral health providers services with a specialization in Allopathic & Osteopathic Physicians, Psychiatry & Neurology (Allopathic & Osteopathic Physicians, Psychiatry & Neurology) (Psychiatry & Neurology: Psychiatry, ) (Behavioral Health/Substance Abuse/Psychiatry, ) (Psychiatry & Neurology Psychiatry, Allopathic & Osteopathic Physicians) (Psychiatry & Neurology, )
| Registration | PART-B:Y DME:Y HHA:Y PMD:Y |
| Entity Type | Individual |
| Provider Name | Nicholas Frank Tacke |
| Practice Office Address | 3181 SW SAM JACKSON PARK RD PORTLAND, OR US |
| Practice Office Telephone | 5034948652 |
| Practice Office Fax | 5034948513 |
| Mailing Address | 3181 SW SAM JACKSON PARK RD PORTLAND, OR 972393011 US |
| Business Telephone | 5034948652 |
| Code | Practice | License No State |
|---|---|---|
| 2084P0800X PRIMARY | Access to Mental Health/Behavioral Health Providers Allopathic & Osteopathic Physicians Psychiatry & Neurology Allopathic & Osteopathic Physicians Psychiatry & Neurology Psychiatry & Neurology: Psychiatry Behavioral Health/Substance Abuse/Psychiatry Psychiatry & Neurology Psychiatry Allopathic & Osteopathic Physicians Psychiatry & Neurology | MD214708
OR |