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NPI Code Detail

MEDICARE: WHITNEE NICOLE NICLEY MS

MEDICARE: WHITNEE NICOLE NICLEY MS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator
2101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1104193994
Entity Type Code : Individual
Provider Name (Legal Business Name) : WHITNEE NICOLE NICLEY MS
Provider Business Mailing Address
First Line : 2221 RIO GRANDE BLVD NW
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87104-2529
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2221 RIO GRANDE BLVD NW
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87104-2529
Country : US
Telephone Number : 505-830-1871
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2011
Last Update Date : 01/03/2018

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Directions to “ WHITNEE NICOLE NICLEY MS” Practice Location

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