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:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1730126343 | NPPES |
| New Mexico | MEDICAID | 39703754 |
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