Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Nicole Dianne Wydra, PA-C

Individual provider Medical Physician Assistant · NPI 1962514836

Nicole Dianne Wydra, PA-C is a Physician Assistant in Corvallis, Oregon. Graduated from Loma Linda University School of Medicine in 2010, 16 years ago. Practices with Brune Dermatology, LLC, a 4-clinician group and accepts Medicare assignment. Licensed in Oregon.

Years since qualifying
16
Trained at
Loma Linda University School of Medicine
Licensed in
OR
In the registry since
2006
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

See every abbreviation used in this directory →

Practice location Address checks out

1740 NW 9th St
Corvallis, OR 97330-2141
Phone: (541) 230-1350
Fax: (541) 207-3477
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence PA153450 (OR)
Physician Assistant Taxonomy 363A00000X

Record details

NPI number1962514836
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedAugust 31, 2006
Last updated in NPPESNovember 3, 2015

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolLOMA LINDA UNIVERSITY SCHOOL OF MEDICINE
Graduated 2010 (16 years in practice)
Group practice Brune Dermatology, Llc — 4 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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