Anderson, Nicole Phoenix

Anderson, Nicole Phoenix is an sole proprietor health care provider with primary practice located at 6501 4Th St Nw F4, Los Ranchos NM 87107-5800. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Anderson, Nicole Phoenix can be contacted via phone (505) 344-9641.

Contact Information

Primary practice address
6501 4Th St Nw F4 Los Ranchos NM 87107-5800
Phone: (505) 344-9641
Fax: (505) 344-2621
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 0976 New Mexico

Profile Details

NPI number 1730126343
LBN Legal business name Anderson, Nicole Phoenix
Credentials PHD
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 1st, 2006
Last updated Jun 20th, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1730126343 NPPES
New Mexico MEDICAID 39703754

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