Doctor Name: | NICOLE E NEDELLA |
NPI Number: | 1407017106 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | DO |
License Number: | R1019 |
Business Practice Address: | 14044 W Camelback Rd Suite 126 Litchfield Park, AZ - 853409428 |
Business Phone Number: | 6239359600 |
Business Fax Number: | 6239359602 |
Mailing Address: | 14044 W Camelback Rd, Suite 126 LITCHFIELD PARK |
State: | AZ |
Postal Code: | 853409428 |
Phone Number: | 6239359600 |
Fax Number: | 6239359602 |
NPI Enumeration Date: | 06/24/2008 |
NPI Last Update Date: | 07/07/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | R1019 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | AZ |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |